North Star Children'S Dentistry, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

NORTH STAR CHILDREN'S DENTISTRY, PC

Practice address

114 Minnie St
Suite a
Fairbanks, AK 99701-3006

Phone

(907) 452-4509

Fax

(907) 457-4509

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Gregory L. Johnson, D.D.S.

Title

President

Phone

(907) 452-4509

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Gregory L. Johnson, DDS, PC Former legal business name

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1154489938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MINNIE ST",
            "address_2": "SUITE A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-452-4509",
            "fax_number": "907-457-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 MINNIE ST",
            "address_2": "SUITE A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-452-4509",
            "fax_number": "907-457-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH STAR CHILDREN'S DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-452-4509",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD0657",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD55881",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gregory L. Johnson, DDS, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Devra Norling, COTAL
• Dallas Paul Norman, MS, LPC, NCC
• Moriah S Norris
• North Country Chiropractic and Natural Health Care LLC
• North Country Medical, LLC
• North Star Council on Aging, Inc.
• North Star Oral & Facial Surgery, LLC
• North Star Plastic Surgery LLC
• North Wind Behavioral Health
• Northern Alaska Medical & Surgical Assoc

• Pediatric Dentistry in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Pediatric Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; 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.