NPIMap

Organization Active NPI

Eagle Summit Dental Group

  • Dentist
  • Eagle River, AK
National Provider Identifier
1629214705
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1086 Issued in AK
Legal business name
EAGLE SUMMIT DENTAL GROUP
Practice address
13015 Old Glenn Hwy
#200
Eagle River, AK 99577
Phone
(907) 694-8234
Fax
(907) 697-8225
NPI assigned
Dec 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
Dr. Michael Roland Sanders, DMDNPI 1538387790
Title
President
Phone
(907) 694-8234

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 MULTIPLE SINGLE SPECIALTY GROUP 122300000X 1086 AK Primary

Addresses

Primary practice location

13015 Old Glenn Hwy
#200
Eagle River, AK 99577

Mailing address

13015 Old Glenn Hwy
#200
Eagle River, AK 99577-8080
Phone (907) 694-8234

Other identifiers 1

IdentifierTypeStateIssuer
1086OtherAKSTATE LICENSE

Other names 1

  • Michael Sanders DMD PC Former legal business name

National Provider Directory

National Provider Directory

Locations

13015 Old Glenn Hwy
Ste 200
Eagle River, AK 99577
Phone (907) 694-8234

Practitioners & affiliated clinicians

Practitioners 1

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": "1229644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1629214705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13015 OLD GLENN HWY",
            "address_2": "#200",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778080",
            "telephone_number": "907-694-8234",
            "fax_number": "907-697-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13015 OLD GLENN HWY",
            "address_2": "#200",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "99577",
            "telephone_number": "907-694-8234",
            "fax_number": "907-697-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE SUMMIT DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-19",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROLAND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "907-694-8234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "1086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1086",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael Sanders DMD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.