Northern Dentistry Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

10026764 Issued in AK

Legal business name

NORTHERN DENTISTRY INC.

Practice address

951 E Bogard Rd
Ste. #203
Wasilla, AK 99654-7175

Phone

(907) 376-2456

Fax

(907) 376-2458

NPI assigned

Nov 23, 2016

Organization subpart

No

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

Authorized official

Name

Charles R. Cordova Jr., DDS

Title

President

Phone

(702) 869-4435

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1487197463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 E BOGARD RD",
            "address_2": "STE. #203",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547175",
            "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 E BOGARD RD",
            "address_2": "STE. #203",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547175",
            "telephone_number": "907-376-2456",
            "fax_number": "907-376-2458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN DENTISTRY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-23",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "CORDOVA JR.",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-869-4435",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "10026764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexia Noel
• Shannon Nolder
• Hans Patrick Nordstrom, DDS
• Emily Norris
• Samantha Jennings Norris, RBT
• Northern Edge Physical Therapy Limited Partnership
• Northern Edge Physical Therapy LLC
• Northern Living Center LLC
• Northern Living Centers, LLC
• Northern Living Centers, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; 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.