Provider Demographics
NPI:1851664858
Name:ALASKA DENTAL CARE, LLC.
Entity Type:Organization
Organization Name:ALASKA DENTAL CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-561-3639
Mailing Address - Street 1:4000 OLD SEWARD HWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-561-3639
Mailing Address - Fax:907-562-5337
Practice Address - Street 1:4000 OLD SEWARD HWY
Practice Address - Street 2:SUITE #100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-561-3639
Practice Address - Fax:907-562-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8751223G0001X
AK2531223G0001X
AK12741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD08755Medicaid