NPIMap

Organization Active NPI

Gamaliel I. Rodriguez, DDS, PC

Doing business as Northern Lights Dental Clinic

  • General Practice Dentistry
  • North Pole, AK
National Provider Identifier
1558726489
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
AA828 Issued in AK
Legal business name
GAMALIEL I. RODRIGUEZ, DDS, PC
Doing business as
Northern Lights Dental Clinic
Practice address
2595 Saint Nicholas Dr
North Pole, AK 99705-7747
Phone
(907) 490-4629
Fax
(907) 490-4649
NPI assigned
Dec 18, 2015
Last updated
Dec 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Authorized official

Name
Gamaliel Issac Rodriguez, DDSNPI 1770597833
Title
Owner
Phone
(907) 490-0127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X AA828 AK Primary

Addresses

Primary practice location

2595 Saint Nicholas Dr
North Pole, AK 99705-7747

Mailing address

2595 Saint Nicholas Dr
North Pole, AK 99705-7747
Phone (907) 490-4629

Other names 1

  • Northern Lights Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

2595 Saint Nicholas Dr
North Pole, AK 99705
Phone (907) 490-0127

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1558726489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 SAINT NICHOLAS DR",
            "city": "NORTH POLE",
            "state": "AK",
            "postal_code": "997057747",
            "telephone_number": "907-490-4629",
            "fax_number": "907-490-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2595 SAINT NICHOLAS DR",
            "city": "NORTH POLE",
            "state": "AK",
            "postal_code": "997057747",
            "telephone_number": "907-490-4629",
            "fax_number": "907-490-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAMALIEL I. RODRIGUEZ, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "GAMALIEL",
        "authorized_official_middle_name": "ISSAC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-490-0127",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "AA828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Lights Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Pole, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.