Mat-Su Dental Center, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

285249 Issued in AK

Legal business name

MAT-SU DENTAL CENTER, INC.

Practice address

951 Bogard Rd
Suite 203
Wasilla, AK 99654-7113

Phone

(907) 376-2456

Fax

(907) 376-2458

NPI assigned

Apr 25, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susanne Kennard

Title

Ceo

Phone

(907) 376-2456

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417177346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 BOGARD RD",
            "address_2": "SUITE 203",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547113",
            "telephone_number": "907-376-2456",
            "fax_number": "907-376-2458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 BOGARD RD",
            "address_2": "SUITE 203",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547113",
            "telephone_number": "907-376-2456",
            "fax_number": "907-376-2458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT-SU DENTAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENNARD",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-376-2456"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "285249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mat-Su Activity and Respite Center
• Mat-Su Activity and Respite Center
• Mat-Su Birth Center, LLC
• Mat-Su Chiropractic LLC (Mat-Su Chiropractic)
• Mat-Su Community Pediatrics, P.C.
• Mat-Su Integrative Medicine
• Mat-Su Medical Laboratory, LLC.
• Mat-Su Mental Health LLC
• Mat-Su Midwifery Inc
• Mat-Su Neurology, LLC

• General Practice Dentistry in Wasilla, AK
• Providers in Wasilla, AK by specialty
• General Practice Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.