Anchorage Dental Care, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

1328 Issued in AK

Legal business name

ANCHORAGE DENTAL CARE, LLC

Practice address

4200 Lake Otis Pkwy
201
Anchorage, AK 99508-5226

Phone

(907) 562-0035

NPI assigned

Jan 13, 2015

Last updated

Jan 13, 2015By 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

Stephan G Howard

Title

Owner Dentist

Phone

(907) 562-0035

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1669861753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 LAKE OTIS PKWY",
            "address_2": "201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085226",
            "telephone_number": "907-562-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 LAKE OTIS PKWY",
            "address_2": "201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085226",
            "telephone_number": "907-562-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCHORAGE DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "STEPHAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "907-562-0035"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002878",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Anchorage, AK
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.