Fairbanks Orthodontic Group a Prof Corp

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

AK9 Issued in AK

Legal business name

FAIRBANKS ORTHODONTIC GROUP A PROF CORP

Practice address

1919 Lathrop St
Suite 102
Fairbanks, AK 99701

Phone

(907) 452-2939

Fax

(907) 451-7330

NPI assigned

Nov 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Walt Babula, DMD MSCO

Title

President Orthodontist

Phone

(907) 452-2939

Specialties & licenses 2

Addresses

Tax ID family

Fairbanks Orthodontic Group a Prof Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fairbanks Orthodontic Group, a Professional Corporation

  • Dental Clinic/Center
  • Fairbanks, AK
  • NPI 1376982918
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter John Babula, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fairbanks, AK
  • NPI 1003170291

  Dentist

  NPD (past)
• Jessica L Woller, DMD, MSD, CO

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fairbanks, AK
  • NPI 1164653473

  Dentist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1013084680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-452-2939",
            "fax_number": "907-451-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99701",
            "telephone_number": "907-452-2939",
            "fax_number": "907-451-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS ORTHODONTIC GROUP A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "BABULA",
        "authorized_official_first_name": "WALT",
        "authorized_official_title_or_position": "PRESIDENT ORTHODONTIST",
        "authorized_official_telephone_number": "907-452-2939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MSCO"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "AK330",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AK",
            "license": "AK9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fairbanks Native Association
• Fairbanks Native Association
• Fairbanks North Star Borough
• Fairbanks North Star Borough School District
• Fairbanks Northstar Borough Van Tran
• Fairbanks Orthodontic Group, a Professional Corporation
• Fairbanks Pain Consulting, LLC
• Fairbanks Physical Therapy LLC
• Fairbanks Psychiatric and Neurological Clinic a Prof Corp
• Fairbanks Radiation Oncology LLC

• All providers in Fairbanks, AK
• Orthodontics and Dentofacial Orthopedics Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.