Active NPI
Dennis P Dussman, DMD
- General Practice Dentistry
- Fairbanks, AK
National Provider Identifier
1154422194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0561
- Practice address
- 3535 College Rd
Suite 202
Fairbanks, AK 99709-3710 - Phone
- (907) 479-8230
- Fax
- (907) 479-4759
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0561 | AK | Primary |
Addresses
Primary practice location
3535 College Rd
Suite 202
Fairbanks, AK 99709-3710
Mailing address
3535 College Rd
Suite 202
Fairbanks, AK 99709-3710
Phone (907) 479-8230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00638684 | Other | AK | STATE EMPLOYER NUMBER |
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 |
|---|---|---|---|
| 0561 | AK | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154422194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3535 COLLEGE RD",
"address_2": "SUITE 202",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093710",
"telephone_number": "907-479-8230",
"fax_number": "907-479-4759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 COLLEGE RD",
"address_2": "SUITE 202",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093710",
"telephone_number": "907-479-8230",
"fax_number": "907-479-4759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUSSMAN",
"first_name": "DENNIS",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AK",
"license": "0561",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE EMPLOYER NUMBER",
"identifier": "00638684",
"state": "AK"
}
],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.