Provider Demographics
NPI:1215021795
Name:ADVANCED DENTAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:ADVANCED DENTAL SOLUTIONS, INC.
Other - Org Name:SMILES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-562-1686
Mailing Address - Street 1:615 E 82ND AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518
Mailing Address - Country:US
Mailing Address - Phone:907-562-1686
Mailing Address - Fax:907-563-6484
Practice Address - Street 1:615 E 82ND AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518
Practice Address - Country:US
Practice Address - Phone:907-562-1686
Practice Address - Fax:907-563-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDO861Medicaid