Jonathan P Woller, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D11967 Issued in MN

Practice address

3535 College Rd
Suite #205
Fairbanks, AK 99709-3722

Phone

(907) 479-6747

Fax

(907) 479-5786

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jonathan P Woller D.M.D. PC

  • Dentist
  • Fairbanks, AK
  • NPI 1407159775
  NPD (past) Authorized official
• Timothy J Woller D.D.S. PC

  • Dentist
  • Fairbanks, AK
  • NPI 1386869527
  NPD (past)

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1144385659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 COLLEGE RD",
            "address_2": "SUITE #205",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093722",
            "telephone_number": "907-479-6747",
            "fax_number": "907-479-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 COLLEGE RD",
            "address_2": "SUITE #205",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093722",
            "telephone_number": "907-479-6747",
            "fax_number": "907-479-5786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLER",
        "first_name": "JONATHAN",
        "middle_name": "P",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11967",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1155",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Wiser, SLP-A
• David Witham, M.D.
• Sarah Louise Witt, MS. ED.
• Sherry Lynne Wolf, RN,MSN,ANP
• Jessica L Woller, DMD, MSD, CO
• Timothy John Woller, D.D.S.
• Brenda Renee Wolverton, P.T.
• Stephanie H Won, RN
• Kimberly Janne Wonderlich, M.D.
• Heidi Wood, PT

• Dentist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.