Provider Demographics
NPI:1053695247
Name:SEARHC
Entity type:Organization
Organization Name:SEARHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-755-4918
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:KLAWOCK
Mailing Address - State:AK
Mailing Address - Zip Code:99925-0069
Mailing Address - Country:US
Mailing Address - Phone:907-755-4918
Mailing Address - Fax:907-755-4811
Practice Address - Street 1:7300 KLAWOCK/HOLLIS HWY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925-0069
Practice Address - Country:US
Practice Address - Phone:907-755-4918
Practice Address - Fax:907-755-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11-075-PDHA I126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty