Moose's Tooth Children's Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MOOSE'S TOOTH CHILDREN'S DENTISTRY, LLC

Practice address

167 S Santa Claus LN Ste B
North Pole, AK 99705-7755

Phone

(907) 268-6644

Fax

(907) 268-6670

NPI assigned

Apr 16, 2018

Last updated

Apr 16, 2018By 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

Dr. Dallin Young, DDS

Title

Owner/President

Phone

(208) 404-9888

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1639666530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MINNIE ST STE A",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 S SANTA CLAUS LN STE B",
            "city": "NORTH POLE",
            "state": "AK",
            "postal_code": "997057755",
            "telephone_number": "907-268-6644",
            "fax_number": "907-268-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE'S TOOTH CHILDREN'S DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "DALLIN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "208-404-9888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in North Pole, AK
• Providers in North Pole, AK by specialty
• Pediatric Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.