Jonathan Robert Oudin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEND1390 Issued in AK

Practice address

1700 E Bogard Rd Ste A201
Wasilla, AK 99654-6569

Phone

(907) 373-8455

Fax

(907) 373-8456

NPI assigned

Aug 4, 2011

Last updated

Jul 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Jonathan Oudin, DDS, LLC

  dba Alaska Center for Dentistry

  • General Practice Dentistry
  • Wasilla, AK
  • NPI 1265167522
  NPD Authorized official

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1427337732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E BOGARD RD STE A201",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546569",
            "telephone_number": "907-373-8455",
            "fax_number": "907-373-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E BOGARD RD STE A201",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546569",
            "telephone_number": "907-373-8455",
            "fax_number": "907-373-8456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1296 Agvik St.",
            "address_purpose": "LOCATION",
            "city": "Barrow",
            "state": "AK",
            "postal_code": "99723",
            "country_code": "US",
            "telephone_number": "907-852-9221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OUDIN",
        "first_name": "JONATHAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "25644",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1390",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "DEND1390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jul 20, 2022; 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.