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Southcentral Foundation — NPI 1043767940, Sutton, AK | NPI Central

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NPI 1043767940

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Southcentral Foundation

NPI 1043767940 · General Practice Dentistry · Sutton, AK

Provider details

NPI number: 1043767940
Entity type: Organization
Primary specialty: General Practice DentistryDental Providers
Parent organization: Southcentral Foundation
Organization subpart: Yes
Authorized official: Ronald Olson, Executive Vice President Finance(907) 729-4939
License: 20467 (AK)

Specialties & taxonomies

General Practice DentistryPrimary1223G0001XLicense 20467 (AK)
Dental Providers

Practice location

11495 N. Callison Street

Sutton, AK 99674

Phone: (907) 631-7665

Approximate (ZIP-level) locationGet directions

More AK providers

Mailing address

Po Box 35151

Seattle, WA 98124-5151

Other names (DBA / former)

Doing business as: Dental- Lifehouse Dental Clinic
Doing business as: Lifehouse Dental Clinic
Doing business as: Lifehouse Dental Clinic

Registry dates

Enumerated: 2016-09-08
Last updated: 2023-08-31
Certified: 2023-08-31

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.