Provider Type Icon

SOUTH ANCHORAGE DENTAL CENTER NPI 1841580966


NPI Information

NPI: 1841580966
Provider Name: SOUTH ANCHORAGE DENTAL CENTER
Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
9170 JEWEL LAKE RD STE 201
ANCHORAGE, AK
ZIP 99502
Phone: (907) 248-7275
Get Directions

SOUTH ANCHORAGE DENTAL CENTER is a preferred provider organization in Anchorage, AK. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. SOUTH ANCHORAGE DENTAL CENTER NPI is 1841580966. The provider is registered as an organization entity type.

The provider's business location address is:

9170 JEWEL LAKE RD STE 201
ANCHORAGE, AK
ZIP 99502-390
Phone: (907) 248-7275
Fax: (907) 248-7221

The provider's authorized official is Broc Wayne Brimhall .
The authorized official title is Dentist and has the following contact phone number (907) 248-7275.

The enumeration date for this NPI number is 4/11/2011 and was last updated on 4/11/2011.


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
1305R00000XPreferred Provider Organization1308ALASKAYes

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
1DD0040MEDICAIDALASKA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.