NPIMap

Organization Active NPI

Coffman Dental, LLC

  • Dentist
  • Wasilla, AK
National Provider Identifier
1568028587
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
COFFMAN DENTAL, LLC
Practice address
351 W Swanson Ave Ste 1
Wasilla, AK 99654-6853
Phone
(907) 376-5315
Fax
(907) 376-7855
NPI assigned
May 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

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

Authorized official

Name
Dr. Justin William Coffman, DDSNPI 1396155131
Title
Member/Owner
Phone
(907) 376-5315

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

351 W Swanson Ave Ste 1
Wasilla, AK 99654-6853

Mailing address

351 W Swanson Ave Ste 1
Wasilla, AK 99654-6853
Phone (907) 376-5315

Other names 1

  • Wasilla Dental Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address clinic@wasilladentalcenter.com

National Provider Directory

National Provider Directory

Locations

351 W Swanson Ave
Ste 1
Wasilla, AK 99654
Phone (907) 376-5315

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557878400000",
    "number": "1568028587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 W SWANSON AVE STE 1",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546853",
            "telephone_number": "907-376-5315",
            "fax_number": "907-376-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 W SWANSON AVE STE 1",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546853",
            "telephone_number": "907-376-5315",
            "fax_number": "907-376-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFMAN DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-05-15",
        "status": "A",
        "authorized_official_last_name": "COFFMAN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "907-376-5315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clinic@wasilladentalcenter.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "address_1": "351 W Swanson Ave Ste 1",
            "city": "Wasilla",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996546853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wasilla Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2019; 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.