NPIMap

Organization Active NPI

Spruce Roots Family Dentistry, LLC

  • General Practice Dentistry
  • Fairbanks, AK
National Provider Identifier
1013528090
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SPRUCE ROOTS FAMILY DENTISTRY, LLC
Practice address
4001 Geist Rd
Ste 5
Fairbanks, AK 99709-3569
Phone
(907) 479-3326
Fax
(907) 479-6410
NPI assigned
Aug 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Chris Willis
Title
Business Manager
Phone
(907) 479-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4001 Geist Rd
Ste 5
Fairbanks, AK 99709-3569

Mailing address

4001 Geist Rd
Ste 5
Fairbanks, AK 99709-3569
Phone (907) 479-3326

National Provider Directory

National Provider Directory

Locations

4001 Geist Rd
Ste 5
Fairbanks, AK 99709
Phone (907) 479-3326

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1013528090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 GEIST RD",
            "address_2": "STE 5",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093569",
            "telephone_number": "907-479-3326",
            "fax_number": "907-479-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 GEIST RD",
            "address_2": "STE 5",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093569",
            "telephone_number": "907-479-3326",
            "fax_number": "907-479-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE ROOTS FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "907-479-3326"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.