Provider Demographics
NPI:1841533155
Name:KEVIN M EASLEY DMD PC
Entity type:Organization
Organization Name:KEVIN M EASLEY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-248-0022
Mailing Address - Street 1:3003 MINNESOTA DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3673
Mailing Address - Country:US
Mailing Address - Phone:907-248-0022
Mailing Address - Fax:907-677-2552
Practice Address - Street 1:3003 MINNESOTA DR
Practice Address - Street 2:STE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3673
Practice Address - Country:US
Practice Address - Phone:907-248-0022
Practice Address - Fax:907-677-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
AK994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6803910001Medicare NSC