Individual provider · NPI-1

Mikayla Kassaiuli

Dental Therapist · Bethel, AK

NPI number1912778473
StatusActive
Last updated in NPPESJan 12, 2024

Details

NPI
1912778473
Entity type
Individual (NPI-1)
Name
Mikayla Kassaiuli
Sex
Female
Sole proprietor
No
Enumeration date
Jan 12, 2024
Certification date
Jan 11, 2024
Last updated
Jan 12, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
125J00000X Dental Therapist23-175-DHATAKYes

Practice location

700 Chief Eddie Hoffman Hwy
Bethel, AK 99559-3427

Phone 907-543-6319

Mailing address

Po Box 3427
Bethel, AK 99559-3427

Phone 907-543-6319

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