Premium Aspect Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AA0649 Issued in AK

Legal business name

PREMIUM ASPECT DENTISTRY, LLC

Practice address

345 Sterling Hwy
Suite 102a
Homer, AK 99603-7820

Phone

(907) 235-3618

Fax

(907) 235-6849

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Douglas Allen Lien, D.D.S.

Title

Managing Member

Phone

(907) 235-3618

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1790858207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 STERLING HWY",
            "address_2": "SUITE 102A",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037820",
            "telephone_number": "907-235-3618",
            "fax_number": "907-235-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 STERLING HWY",
            "address_2": "SUITE 102A",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037820",
            "telephone_number": "907-235-3618",
            "fax_number": "907-235-6849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM ASPECT DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "LIEN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "907-235-3618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "AA0649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLAIMS SUBMISSION ID",
            "identifier": "663219",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD06492",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Homer, AK
• Providers in Homer, AK by specialty
• General Practice Dentistry in Alaska

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