NPI 1841580966

South Anchorage Dental Center

Organisation Preferred Provider Organization Anchorage, AK

Practice location

Address: 9170 Jewel Lake Rd STE 201, Anchorage, AK 99502-5390
Phone: (907) 248-7275
Fax: (907) 248-7221

Authorised official

Name: Broc Wayne Brimhall
Title: Dentist
Phone: (907) 248-7275

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 1308 (AK)

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Registry record

NPI: 1841580966
Entity type: Organization
NPI issued: 11 Apr 2011
Record last updated: 11 Apr 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.