NPIMap

Organization Active NPI

Southeast Dental Group, PC

  • Dentist
  • Juneau, AK
National Provider Identifier
1780706838
Registry record updated Feb 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
963 Issued in AK
Legal business name
SOUTHEAST DENTAL GROUP, PC
Practice address
2220 Dunn St
Juneau, AK 99801-1430
Phone
(907) 586-9885
Fax
(907) 586-1849
NPI assigned
Apr 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2014

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

Authorized official

Name
Dr. Kristen J Schultz, D.D.S.NPI 1558784322
Title
Dentist Vice President
Phone
(907) 586-9885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 963 AK Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 7435 CO
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 7113 CO
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 961 AK

Addresses

Primary practice location

2220 Dunn St
Juneau, AK 99801-1430

Mailing address

2220 Dunn St
Juneau, AK 99801-9304
Phone (907) 586-9885

Other identifiers 2

IdentifierTypeStateIssuer
DDO961MedicaidAK
963OtherAKSTATE OF ALASKA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391472000000",
    "number": "1780706838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 DUNN ST",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998019304",
            "telephone_number": "907-586-9885",
            "fax_number": "907-586-1849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 DUNN ST",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998011430",
            "telephone_number": "907-586-9885",
            "fax_number": "907-586-1849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2014-02-04",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST VICE PRESIDENT",
        "authorized_official_telephone_number": "907-586-9885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "963",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "7435",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "7113",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AK",
            "license": "961",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DDO961",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ALASKA",
            "identifier": "963",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Juneau, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; 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.