NPIMap

Organization Active NPI

Lakeview Professional Dental Associates Inc.

  • Dentist
  • Wasilla, AK
National Provider Identifier
1720116601
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
348 Issued in AK
Legal business name
LAKEVIEW PROFESSIONAL DENTAL ASSOCIATES INC.
Practice address
851 Westpoint Dr
Suite 112
Wasilla, AK 99654-7142
Phone
(907) 376-4415
Fax
(907) 373-0589
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jean Kingslien
Title
Director Secretary Treasurer
Phone
(907) 346-2625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 348 AK Primary

Addresses

Primary practice location

851 Westpoint Dr
Suite 112
Wasilla, AK 99654-7142

Mailing address

851 Westpoint Dr
Suite 112
Wasilla, AK 99654-7142
Phone (907) 376-4415

National Provider Directory

National Provider Directory

Locations

851 E Westpoint Dr
Ste 112
Wasilla, AK 99654
Phone (907) 376-4415

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720116601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 WESTPOINT DR",
            "address_2": "SUITE 112",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547142",
            "telephone_number": "907-376-4415",
            "fax_number": "907-373-0589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 WESTPOINT DR",
            "address_2": "SUITE 112",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547142",
            "telephone_number": "907-376-4415",
            "fax_number": "907-373-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW PROFESSIONAL DENTAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KINGSLIEN",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR SECRETARY TREASURER",
        "authorized_official_telephone_number": "907-346-2625"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.