Provider Demographics
NPI:1659578037
Name:EAST, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:EAST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3171
Mailing Address - Country:US
Mailing Address - Phone:907-336-3030
Mailing Address - Fax:907-336-3029
Practice Address - Street 1:13030 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3171
Practice Address - Country:US
Practice Address - Phone:907-336-3030
Practice Address - Fax:907-336-3029
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK8981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice