Provider Demographics
NPI:1821356262
Name:ZIEGLER, ANNE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:KRAGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3470 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-373-8684
Mailing Address - Fax:
Practice Address - Street 1:3470 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7294
Practice Address - Country:US
Practice Address - Phone:907-373-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK30-0236841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1613813Medicaid