Provider Demographics
NPI:1669099420
Name:PENTECOSTES, DIONISIO
Entity type:Individual
Prefix:
First Name:DIONISIO
Middle Name:
Last Name:PENTECOSTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4702
Mailing Address - Country:US
Mailing Address - Phone:907-338-9588
Mailing Address - Fax:
Practice Address - Street 1:8211 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4702
Practice Address - Country:US
Practice Address - Phone:907-338-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility