FAIRBANKS ORTHODONTIC GROUP A PROFESSIONAL CORPORATION NPI 1376982918

NPI Information

NPI: 1376982918
Provider Name: FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
1919 LATHROP ST
SUITE 102
FAIRBANKS, AK
ZIP 99701
Phone: (907) 452-2939
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FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION is a dental clinic center in Fairbanks, AK. FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION NPI is 1376982918. The provider is registered as an organization entity type.

The provider's business location address is:

1919 LATHROP ST
SUITE 102
FAIRBANKS, AK
ZIP 99701-937
Phone: (907) 452-2939
Fax: (907) 451-7330

The provider's authorized official is Jessica Woller .
The authorized official title is Orthodontist and has the following contact phone number (907) 452-2939.

The enumeration date for this NPI number is 6/17/2013 and was last updated on 6/17/2013.

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	261QD0000X	Clinic/Center	Dental	1249	ALASKA	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	GR0227	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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