Provider Demographics
NPI:1417096579
Name:STRAUBE, JOHN L (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:STRAUBE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 BONIFACE PKWY
Mailing Address - Street 2:2906 BONIFACE PKWY
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3132
Mailing Address - Country:US
Mailing Address - Phone:907-337-6453
Mailing Address - Fax:907-338-6654
Practice Address - Street 1:2906 BONIFACE PKWY
Practice Address - Street 2:2906 BONIFACE PKWY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3132
Practice Address - Country:US
Practice Address - Phone:907-337-6453
Practice Address - Fax:907-338-6654
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDO481Medicaid
AK0696Medicare UPIN