Phyllis Lynn Pendergrast, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0477 Issued in AK

Practice address

3539 Thomas St
Fairbanks, AK 99709

Phone

(907) 452-7041

Fax

(907) 451-7166

NPI assigned

Jun 18, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Phyllis Lynn Everhardt Other name

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Phyllis Pendergrast, D.M.D., a.P.C.

  • Dentist
  • Fairbanks, AK
  • NPI 1639381429
  NPD (past) Authorized official

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1457765471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3539 THOMAS ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-452-7041",
            "fax_number": "907-451-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3539 THOMAS ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-452-7041",
            "fax_number": "907-451-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAST",
        "first_name": "PHYLLIS",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "0477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "EVERHARDT",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sarah Calumbine Pegouskie, APRN, FNP
• Maria Pelkola
• Linda Lee Peluso
• Holly-Marie Pena
• Angela Marie Penatac, HEALTH AIDE
• Ryan M Pennington
• Amanda Penwell, CDM
• Myah Peoples
• Aisha Pereira
• Alejandra Perez, LMT

• Dentist in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.