NPIMap

Organization Active NPI

Four Corners Dental Group Fairbanks

  • General Practice Dentistry
  • Fairbanks, AK
National Provider Identifier
1710310073
Registry record updated Aug 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1262 Issued in AK
Legal business name
FOUR CORNERS DENTAL GROUP FAIRBANKS
Practice address
3487 Airport Way
Fairbanks, AK 99709-4761
Phone
(907) 479-7771
Fax
(907) 479-7772
NPI assigned
Aug 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2013

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

Authorized official

Name
Dr. Shane D Rhoton
Title
Dentist
Phone
(907) 479-7771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 1262 AK Primary

Addresses

Primary practice location

3487 Airport Way
Fairbanks, AK 99709-4761

Mailing address

3487 Airport Way
Fairbanks, AK 99709-4761
Phone (907) 479-7771

Other identifiers 1

IdentifierTypeStateIssuer
DD0143MedicaidAK

National Provider Directory

National Provider Directory

Locations

3487 Airport Way
Fairbanks, AK 99709
Phone (907) 479-7771

Practitioners & affiliated clinicians

Practitioners 6

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": "1376006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376006400000",
    "number": "1710310073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3487 AIRPORT WAY",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094761",
            "telephone_number": "907-479-7771",
            "fax_number": "907-479-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3487 AIRPORT WAY",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094761",
            "telephone_number": "907-479-7771",
            "fax_number": "907-479-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS DENTAL GROUP FAIRBANKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-09",
        "last_updated": "2013-08-09",
        "status": "A",
        "authorized_official_last_name": "RHOTON",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "907-479-7771",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "1262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD0143",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; 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.