Organization · NPI-2

Bridgeview Dental Group LLC

Dentist, General Practice · Kodiak, AK

NPI number1134588619
StatusActive
Last updated in NPPESFeb 12, 2016

Details

NPI
1134588619
Entity type
Organization (NPI-2)
Legal business name
Bridgeview Dental Group LLC
Organization subpart
No
Enumeration date
Feb 12, 2016
Last updated
Feb 12, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice1137AKYes

Practice location

413 Rezanof Dr E
Kodiak, AK 99615-6367

Phone 907-622-7874 · Fax 907-622-7872

Mailing address

12641 Old Glenn Hwy Ste 204
Eagle River, AK 99577

Phone 907-622-7874 · Fax 907-622-7872

Authorized official

James Penfield
Owner
9076227874

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