Provider Demographics
NPI:1417267337
Name:ANCHORAGE PEDIATRIC DENTISTRY, INC
Entity Type:Organization
Organization Name:ANCHORAGE PEDIATRIC DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRANT
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-229-0629
Mailing Address - Street 1:4200 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5226
Mailing Address - Country:US
Mailing Address - Phone:907-562-1003
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5226
Practice Address - Country:US
Practice Address - Phone:907-562-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKD1371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty