NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as Dental- ANMC Dental Clinic (Eaglesoft & Dolphin)

  • Dentist
  • Anchorage, AK
National Provider Identifier
1861533408
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
Dental- ANMC Dental Clinic (Eaglesoft & Dolphin)
Dental- Fireweed Dental Clinic ( Eaglesoft & Dolph
Dental- Village Dental Clinic ( Eaglesoft & Dolphi
Practice address
4341 Tudor Centre Dr
Anchorage, AK 99508-5904
Phone
(907) 729-2000
NPI assigned
Feb 8, 2007
Last updated
Sep 18, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Authorized official

Name
Ronald Lee Olson
Title
Executive Vice President Finance
Phone
(907) 729-4939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

4341 Tudor Centre Dr
Anchorage, AK 99508-5904

Mailing address

PO Box 35151
Seattle, WA 98124-5151

Other practice location 1

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 729-2000

Other identifiers 3

IdentifierTypeStateIssuer
1580817MedicaidAK
1003875MedicaidAK
1636631MedicaidAK

Other names 3

  • Dental- ANMC Dental Clinic (Eaglesoft & Dolphin) Doing business as
  • Dental- Fireweed Dental Clinic ( Eaglesoft & Dolph Doing business as
  • Dental- Village Dental Clinic ( Eaglesoft & Dolphi Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southcentral Foundation PDN103 organizations share this tax ID, including this one
Part of
Southcentral Foundation PDN

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

4341 Tudor Centre Dr
Fl First
Anchorage, AK 99508

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1861533408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35151",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 TUDOR CENTRE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085904",
            "telephone_number": "907-729-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4315 Diplomacy Dr",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995085926",
            "country_code": "US",
            "telephone_number": "907-729-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2007-02-08",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1580817",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003875",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1636631",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental- ANMC Dental Clinic (Eaglesoft & Dolphin)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental- Fireweed Dental Clinic ( Eaglesoft & Dolph",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental- Village Dental Clinic ( Eaglesoft & Dolphi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.