Active NPI
Del Jean Dedeker, DDS
- Dentist
- Wasilla, AK
National Provider Identifier
1033394234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 845
- Practice address
- 4501 E Snider Dr
Wasilla, AK 99654 - Phone
- (907) 376-8400
- Fax
- (907) 376-8402
- NPI assigned
- Jan 7, 2008
- Last updated
- Jan 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 845 | AK | Primary |
Addresses
Primary practice location
4501 E Snider Dr
Wasilla, AK 99654
Mailing address
4501 E Snider Dr
Wasilla, AK 99654
Phone (907) 376-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 845 | AK | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199664000000",
"number": "1033394234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 E SNIDER DR",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-376-8400",
"fax_number": "907-376-8402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 E SNIDER DR",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-376-8400",
"fax_number": "907-376-8402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDEKER",
"first_name": "DEL",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-07",
"last_updated": "2008-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.