Provider Demographics
NPI:1487025268
Name:TUNDRA KIDS DENTISTRY LLC
Entity type:Organization
Organization Name:TUNDRA KIDS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROALOFS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:9007-232-5135
Mailing Address - Street 1:2051 GLACIER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3723
Mailing Address - Country:US
Mailing Address - Phone:907-232-5135
Mailing Address - Fax:
Practice Address - Street 1:1000 GREG KRUSCHEK AVE.
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty