Southcentral Foundation
NPI 1124603733ActiveOrganization· Dentist, General Practice· Wasilla, AK
Dentist, General Practice in Wasilla, Alaska, registered in NPPES in March 2021, part of Southcentral Foundation. The authorized official on file is Ronald Lee Olson, Executive Vice President Finance.
Overview
| NPI | 1124603733 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Southcentral Foundation |
| NPI issued | Mar 15, 2021 |
| Last updated in NPPES | Jun 5, 2026 |
| Certified by provider | Jun 5, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | — | — |
| Clinic/Center, Multi-Specialty | 261QM1300X | — | — |
| Clinic/Center, Medical Specialty | 261QM2500X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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