Mark Robert Birmingham

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

106211 Issued in AK

Practice address

4501 E Snider Dr
Wasilla, AK 99654-7604

Phone

(907) 376-8400

Fax

(907) 376-8402

NPI assigned

Feb 17, 2016

Last updated

Feb 17, 2016By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1538528641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 E SNIDER DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547604",
            "telephone_number": "907-376-8400",
            "fax_number": "907-376-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 E SNIDER DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547604",
            "telephone_number": "907-376-8400",
            "fax_number": "907-376-8402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRMINGHAM",
        "first_name": "MARK",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "106211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003845",
            "state": "AK"
        }
    ],
    "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 Feb 17, 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.