Provider Demographics
NPI:1265536379
Name:ALBERTSON, DAVID A (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CARLANNA LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-225-9631
Mailing Address - Fax:907-225-4591
Practice Address - Street 1:130 CARLANNA LAKE ROAD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-225-9631
Practice Address - Fax:907-225-4591
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0754Medicaid