Active NPI
Brian D Wight, DDS
- Dentist
- Wasilla, AK
National Provider Identifier
1386766673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1067
- Practice address
- 351 W Swanson
#1
Wasilla, AK 99654 - Phone
- (907) 376-5315
- Fax
- (907) 376-7855
- NPI assigned
- Apr 6, 2007
- Sex
- Male
- 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 | 1067 | AK | Primary |
Addresses
Primary practice location
351 W Swanson
#1
Wasilla, AK 99654
Mailing address
19716 Revilla Circle
Eagle River, AK 99577
Phone (907) 622-6017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 18, 2017 through Jun 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1067 | AK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coffman Dental, LLC | Dentist | Past | Accepting new patients |
| Robert Cassell DDS PC Wasilla Dental Center | Dentist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Wasilla, AK
- NPI 1568028587
-
- Dentist
- Wasilla, AK
- NPI 1528078045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386766673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19716 REVILLA CIRCLE",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "99577",
"telephone_number": "907-622-6017",
"fax_number": "907-376-7855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 W SWANSON",
"address_2": "#1",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-376-5315",
"fax_number": "907-376-7855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIGHT",
"first_name": "BRIAN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "1067",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.