GLACIER DENTAL LLC NPI 1093042194

NPI Information

NPI: 1093042194
Provider Name: GLACIER DENTAL, LLC

Doing Business As: DR. JEON'S IMPLANT DENTISTRY

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2421 E TUDOR RD
SUITE 101
ANCHORAGE, AK
ZIP 99507
Phone: (907) 222-6000
Get Directions

GLACIER DENTAL, LLC is a dental clinic center in Anchorage, AK. GLACIER DENTAL, LLC NPI is 1093042194. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dr. Jeon's Implant Dentistry.

The provider's business location address is:

2421 E TUDOR RD
SUITE 101
ANCHORAGE, AK
ZIP 99507-166
Phone: (907) 222-6000
Fax: (907) 333-3390

The provider's authorized official is Joshua Jeon .
The authorized official title is Ceo and has the following contact phone number (907) 222-6000.

The enumeration date for this NPI number is 11/10/2009 and was last updated on 1/11/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	1239	ALASKA	No
2	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	DD2134	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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