Provider Demographics
NPI:1750604195
Name:PATRICK G DORMAN DDS PC
Entity type:Organization
Organization Name:PATRICK G DORMAN DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZONA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-561-2475
Mailing Address - Street 1:3501 DENALI ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4039
Mailing Address - Country:US
Mailing Address - Phone:907-561-2475
Mailing Address - Fax:907-562-0786
Practice Address - Street 1:3501 DENALI ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4039
Practice Address - Country:US
Practice Address - Phone:907-561-2475
Practice Address - Fax:907-562-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6831223G0001X
AK13271223G0001X
AK6971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD33022Medicaid
AKDD06971Medicaid