Provider Demographics
NPI:1780849547
Name:JOHNSON, DEVIN PHILLIPS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:PHILLIPS
Last Name:JOHNSON
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 1:2000 ABBOTT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3878
Mailing Address - Country:US
Mailing Address - Phone:907-561-1902
Mailing Address - Fax:907-562-2952
Practice Address - Street 1:2000 ABBOTT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3878
Practice Address - Country:US
Practice Address - Phone:907-561-1902
Practice Address - Fax:907-562-2952
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198631223G0001X
AK1751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice