Ketchikan Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KETCHIKAN DENTAL

Practice address

130 Carlanna Lake Rd
Ketchikan, AK 99901-5669

Phone

(909) 967-8052

Fax

(907) 331-4220

NPI assigned

Jan 30, 2024

Last updated

Jan 30, 2024By 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

Tanner D Zylstra, DDSNPI 1588141220

Title

Owner

Phone

(909) 967-8052

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanner Douglas Zylstra, DDS

  • Dentist
  • Fairbanks, AK
  • NPI 1588141220
  NPD Authorized official

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1518720911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CARLANNA LAKE RD",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015669",
            "telephone_number": "909-967-8052",
            "fax_number": "907-331-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CARLANNA LAKE RD",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015669",
            "telephone_number": "909-967-8052",
            "fax_number": "907-331-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETCHIKAN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "ZYLSTRA",
        "authorized_official_first_name": "TANNER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-967-8052",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxx Ritchie Keizer, PHARMD
• Erin Kelly
• Sherity L Kelly
• Ashley Kessler
• Alice Ketah
• Ketchikan Emergency Physicians, LLC
• Ketchikan Eye Care Center, L.L.C.
• Ketchikan Functional Medicine
• Ketchikan Gateway Borough
• Ketchikan Gateway Borough School District

• General Practice Dentistry in Ketchikan, AK
• Providers in Ketchikan, 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 Jan 30, 2024; 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.