South Anchorage Dental Clinic LLC

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

AA625 Issued in AK

Legal business name

SOUTH ANCHORAGE DENTAL CLINIC LLC

Practice address

9170 Jewel Lake Road
Suite 201
Anchorage, AK 99502

Phone

(907) 248-7275

Fax

(907) 248-7221

NPI assigned

Jun 17, 2008

Last updated

Jun 17, 2008By 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

Scott Hebertson, DDS

Title

President

Phone

(907) 248-7275

Specialties & licenses 2

Addresses

Locations

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.

• Matthew Boyce, DMD

  • Dentist
  • Anchorage, AK
  • NPI 1144153818
  NPD (past)
• Broc Wayne Brimhall, D.M.D

  • General Practice Dentistry
  • Anchorage, AK
  • NPI 1386874113
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1568623106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9170 JEWEL LAKE ROAD",
            "address_2": "SUITE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99502",
            "telephone_number": "907-248-7275",
            "fax_number": "907-248-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9170 JEWEL LAKE ROAD",
            "address_2": "SUITE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99502",
            "telephone_number": "907-248-7275",
            "fax_number": "907-248-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ANCHORAGE DENTAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-17",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "HEBERTSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-248-7275",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "AK",
            "license": "1009",
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "AK",
            "license": "AA625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Gate Cosmetic & Implant Dentistry LLC

• Dental Assistant in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Dental Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.