Kodiak Island Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KODIAK ISLAND FAMILY DENTISTRY

Practice address

204 E Rezanof Dr Ste 201
Kodiak, AK 99615-6379

Phone

(907) 481-3567

NPI assigned

Jul 8, 2021

Organization subpart

No

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

Authorized official

Name

Tabitha Leiva

Title

Office Manager

Phone

(907) 481-3567

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hyrum Murdoch, DMD

  • General Practice Dentistry
  • Anchorage, AK
  • NPI 1326421850
  NPD
• Ambika Rani Srivastava, DMD, MPH

  • General Practice Dentistry
  • Tuscaloosa, AL
  • NPI 1639787021
  NPD

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625702400000",
    "number": "1811568900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E REZANOF DR STE 201",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156379",
            "telephone_number": "907-481-3567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E REZANOF DR STE 201",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156379",
            "telephone_number": "907-481-3567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODIAK ISLAND FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A",
        "authorized_official_last_name": "LEIVA",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "907-481-3567"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437243326",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326421850",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639787021",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kodiak Cubs Speech
• Kodiak Diagnostic Imaging, Professional Corporation
• Kodiak Island Ambulatory Care Clinic Inc.
• Kodiak Island Assisted Living, LLC
• Kodiak Island Assisted Living, LLC
• Kodiak Island Health Care Foundation (Kodiak Community Health Center)
• Kodiak Island Health Care Foundation (Kodiak Community Health Center Pharmacy)
• Kodiak Island Medical Associates LLC
• Kodiak Island Medical Associates LLC
• Kodiak Life Diagnostic Imaging, Inc

• Dental Clinic/Center in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Dental Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.