MINNIE STREET CHILDREN'S DENTISTRY PC NPI 1770250292

NPI Information

NPI: 1770250292
Provider Name: MINNIE STREET CHILDREN'S DENTISTRY, PC
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
114 MINNIE ST STE B
FAIRBANKS, AK
ZIP 99701
Phone: (907) 308-2200
Get Directions

MINNIE STREET CHILDREN'S DENTISTRY, PC is a pediatric dentistry dentist in Fairbanks, AK. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. MINNIE STREET CHILDREN'S DENTISTRY, PC NPI is 1770250292. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

114 MINNIE ST STE B
FAIRBANKS, AK
ZIP 99701-000
Phone: (907) 308-2200

The provider's authorized official is Gregory L Johnson .
The authorized official title is Member and has the following contact phone number (907) 479-8844.

The enumeration date for this NPI number is 8/24/2021 and was last updated on 8/24/2021.

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	1223P0221X	Dentist	Pediatric Dentistry			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	UNKNOWN	OTHER	ALASKA	UNKNOWN

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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