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PEDIATRIC DENTISTRY OF ALASKA NPI 1568616548


NPI Information

NPI: 1568616548
Provider Name: PEDIATRIC DENTISTRY OF ALASKA

Doing Business As: PEDIATRIC DENTISTRY OF ALASKA

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

Specialization: Dental

Address:
3470 E MERIDIAN PARK LOOP
WASILLA, AK
ZIP 99654
Phone: (907) 373-8684
Get Directions

PEDIATRIC DENTISTRY OF ALASKA is a dental clinic center in Wasilla, AK. PEDIATRIC DENTISTRY OF ALASKA NPI is 1568616548. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pediatric Dentistry Of Alaska.

The provider's business location address is:

3470 E MERIDIAN PARK LOOP
WASILLA, AK
ZIP 99654
Phone: (907) 373-8684
Fax: (907) 373-8465

The provider's authorized official is Roger Duane Beck .
The authorized official title is Owner/president and has the following contact phone number (907) 373-8684.

The enumeration date for this NPI number is 11/4/2008 and was last updated on 9/12/2018.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric Dentistry924ALASKANo
2261QD0000XClinic/CenterDental924ALASKAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11003811MEDICAIDALASKA
21583802MEDICAIDALASKA

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

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