NPIMap

Organization Active NPI

Foothills Dentistry Alaska, LLC

  • Dentist
  • Anchorage, AK
National Provider Identifier
1639416001
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1024 Issued in AK
Legal business name
FOOTHILLS DENTISTRY ALASKA, LLC
Practice address
4001 Lake Otis Pkwy
Suite 100
Anchorage, AK 99508-5200
Phone
(907) 280-9585
NPI assigned
Jan 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

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

Authorized official

Name
Franklin T Wortham
Title
Owner
Phone
(907) 280-9585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 1024 AK Primary

Addresses

Primary practice location

4001 Lake Otis Pkwy
Suite 100
Anchorage, AK 99508-5200

Mailing address

4001 Lake Otis Pkwy
Suite 100
Anchorage, AK 99508-5200
Phone (907) 280-9585

Other identifiers 1

IdentifierTypeStateIssuer
1582133MedicaidAK

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1357344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1639416001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 LAKE OTIS PKWY",
            "address_2": "SUITE 100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085200",
            "telephone_number": "907-280-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 LAKE OTIS PKWY",
            "address_2": "SUITE 100",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085200",
            "telephone_number": "907-280-9585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS DENTISTRY ALASKA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-05",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "WORTHAM",
        "authorized_official_first_name": "FRANKLIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-280-9585"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "1024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582133",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; 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.