South Anchorage Dental Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

1308 Issued in AK

Legal business name

SOUTH ANCHORAGE DENTAL CENTER

Practice address

9170 Jewel Lake Rd Ste 201
Anchorage, AK 99502-5390

Phone

(907) 248-7275

Fax

(907) 248-7221

NPI assigned

Apr 11, 2011

Organization subpart

No

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

Authorized official

Name

Broc Wayne Brimhall, DMDNPI 1386874113

Title

Dentist

Phone

(907) 248-7275

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Broc Wayne Brimhall, D.M.D

  • General Practice Dentistry
  • Anchorage, AK
  • NPI 1386874113
  NPD (past) Authorized official
• Matthew Boyce, DMD

  • Dentist
  • Anchorage, AK
  • NPI 1144153818
  NPD (past)

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1841580966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9170 JEWEL LAKE RD STE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995025390",
            "telephone_number": "907-248-7275",
            "fax_number": "907-248-7221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9170 JEWEL LAKE RD STE 201",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995025390",
            "telephone_number": "907-248-7275",
            "fax_number": "907-248-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ANCHORAGE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "BRIMHALL",
        "authorized_official_first_name": "BROC",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "907-248-7275",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AK",
            "license": "1308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DD0040",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sound Choice Alaska, Inc
• Sound Decisions Audiology LLC
• Soundheart Counseling LLC
• Source Pelvic Health
• Sourdough's Housing LLC (Marlow Manor Assisted Living)
• South Anchorage Dental Clinic LLC
• South Anchorage Family Dentistry LLC (True North Family Dental)
• South Anchorage Physical Therapy Inc
• South Anchorage Speech Solutions, LLC
• South Anchorage Surgery Center, LLC

• Preferred Provider Organization in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Preferred Provider Organization in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.