Individual provider Active NPI

Kevin M. Easley, D.M.D.

  • Dentist
  • Anchorage, AK
National Provider Identifier
1821006347
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
920175036 Issued in AK
Practice address
330 E Tudor Rd
Anchorage, AK 99503-7369
Phone
(907) 248-0022
Fax
(907) 206-3905
NPI assigned
Aug 3, 2006
Last updated
Jul 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 920175036 AK Primary

Addresses

Primary practice location

330 E Tudor Rd
Anchorage, AK 99503-7369

Mailing address

3031 Lakeside Dr
Anchorage, AK 99515-2202
Phone (907) 248-0022

Other identifiers 1

IdentifierTypeStateIssuer
920175036OtherAKTAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120124000391 AK Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3779750211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin M Easley DMD PC Dentist CurrentSince Mar 15, 2001 Accepting new patients

Locations

3003 Minnesota Dr
Ste 200
Anchorage, AK 99503
Phone (907) 248-0022

330 E Tudor Rd
Anchorage, AK 99503
Phone (907) 248-0022

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1821006347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 LAKESIDE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995152202",
            "telephone_number": "907-248-0022",
            "fax_number": "907-677-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995037369",
            "telephone_number": "907-248-0022",
            "fax_number": "907-206-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASLEY",
        "first_name": "KEVIN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "920175036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "920175036",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.