NPIMap

Organization Active NPI

Pediatric Dentistry of Alaska

  • Dental Clinic/Center
  • Wasilla, AK
National Provider Identifier
1568616548
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
924 Issued in AK
Legal business name
PEDIATRIC DENTISTRY OF ALASKA
Doing business as
Pediatric Dentistry of Alaska
Practice address
3470 E Meridian Park Loop
Wasilla, AK 99654
Phone
(907) 373-8684
Fax
(907) 373-8465
NPI assigned
Nov 4, 2008
Last updated
Sep 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Authorized official

Name
Roger Duane Beck, DDANPI 1992822811
Title
Owner/President
Phone
(907) 373-8684

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 924 AK Primary
Pediatric Dentistry 1223P0221X 924 AK

Addresses

Primary practice location

3470 E Meridian Park Loop
Wasilla, AK 99654

Mailing address

3470 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 373-8684

Other identifiers 2

IdentifierTypeStateIssuer
1583802MedicaidAK
1003811MedicaidAK

Other names 1

  • Pediatric Dentistry of Alaska Doing business as

National Provider Directory

National Provider Directory

Locations

3470 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 373-8684

Practitioners & affiliated clinicians

Practitioners 8

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": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1568616548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-8684",
            "fax_number": "907-373-8465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3470 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-8684",
            "fax_number": "907-373-8465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF ALASKA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "BECK",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "907-373-8684",
        "authorized_official_credential": "DDA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AK",
            "license": "924",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AK",
            "license": "924",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1583802",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003811",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Alaska",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry of Alaska",
            "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 Sep 12, 2018; 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.