Provider Demographics
NPI:1568024388
Name:NORTH COAST FAMILY DENTISTRY
Entity Type:Organization
Organization Name:NORTH COAST FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SERGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-344-2483
Mailing Address - Street 1:2020 ABBOTT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507
Mailing Address - Country:US
Mailing Address - Phone:907-344-2483
Mailing Address - Fax:907-349-2489
Practice Address - Street 1:2020 ABBOTT RD STE 1
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4624
Practice Address - Country:US
Practice Address - Phone:907-344-2483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584714Medicaid
AK1500OtherDENTIST