FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION (NPI# 1376982918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376982918 |
| Entity Type | Organization |
| Organization Name | FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION |
| Practice Address |
1919 Lathrop St Suite 102 Fairbanks AK 99701-5937 |
| Practice Telephone | 9074522939 |
| Practice Fax Number | 9074517330 |
| Mailing Telephone | 9074522939 |
| Mailing Fax Number | 9074517330 |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2013-06-17 |
| Authorized Official Name | DR. JESSICA WOLLER (ORTHODONTIST) |
| Authorized Official Telephone | 9074522939 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
1249 | AK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | GR0227 | 05 |
| Street Address |
1919 LATHROP ST SUITE 102 |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701-5937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699774299 | Letha C Archer | Pediatrics | 1919 Lathrop St, Suite 100, Fairbanks, AK 99701-5937 | 2005-07-18 |
| 1245708668 | Tanana Valley Clinic LLC | Clinic/Center | 1919 Lathrop St, Fairbanks, AK 99701-5937 | 2018-11-03 |
| 1275084626 | Jeffrey W. Kilgore Dmd PC | Dentist | 1919 Lathrop St, Ste: 211, Fairbanks, AK 99701-5937 | 2016-10-20 |
| 1992256341 | Otter Dental | Dentist | 1919 Lathrop St, Suite 211, Fairbanks, AK 99701-5937 | 2016-10-20 |
| 1467909218 | Rebecca Rengel | Physical Therapist | 1919 Lathrop St, Ste 123, Fairbanks, AK 99701-5937 | 2016-09-08 |
| 1538613203 | Brent Little | Physical Therapist | 1919 Lathrop St, Suite 123, Fairbanks, AK 99701-5937 | 2016-08-10 |
| 1396298626 | Nicholas Nzioka Ndetti Jr. | Pharmacist | 1919 Lathrop St, Suite 109, Fairbanks, AK 99701-5937 | 2016-08-03 |
| 1366829699 | Karolina Priebe | Nurse Practitioner | 1919 Lathrop St, Suite 101, Fairbanks, AK 99701-5937 | 2015-05-06 |
| 1124405618 | David Boyd | Specialist/Technologist | 1919 Lathrop St, Suite 123, Fairbanks, AK 99701-5937 | 2015-05-04 |
| 1679903140 | Heidi Wood | Physical Therapist | 1919 Lathrop St, #123, Fairbanks, AK 99701-5937 | 2013-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659984987 | Resource Center for Parents & Children, Inc. | Social Worker | 726 26th Ave, Suite #2, Fairbanks, AK 99701 | 2020-08-26 |
| 1134738982 | Aaron Paul Sarauer | Behavior Technician | 3121 Lathrop St., Fairbanks, AK 99701 | 2020-07-28 |
| 1437715505 | Fabienne Rose Marie Siddall | Case Manager/Care Coordinator | 122 1st Avenue, Fairbanks, AK 99701 | 2019-05-14 |
| 1902461957 | Jacqueline Marie Rahm | Counselor | Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 | 2019-05-06 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1922519305 | Sarishma Sangeeta Lal | Registered Nurse | 815 2nd Ave Ste 122, Fairbanks, AK 99701 | 2017-10-12 |
| 1245690569 | Christine L Simko | Naturopath | 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 | 2016-02-29 |
| 1932581600 | Jennifer Davis | Registered Nurse | 1025 West Barnette St., Fairbanks, AK 99701 | 2015-06-18 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1578957460 | Mara Justine Becker | Physician Assistant | 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 | 2015-03-27 |
| Find all providers in zip 99701 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609055029 | Pete B Higgins Dds LLC | Clinic/Center | 4001 Geist Rd Ste 3, Fairbanks, AK 99709-3569 | 2007-11-01 |
| 1558772277 | Gerik Dental, Inc | Clinic/Center | 1305 21st Ave, Suite #102, Fairbanks, AK 99701-6084 | 2014-05-15 |
| 1124244181 | Interior Community Health Center Dental Prog | Clinic/Center | 1606 23rd Ave, Fairbanks, AK 99701-6407 | 2007-04-18 |
| 1205978228 | Denali Dental Associates, LLC | Clinic/Center | 528 5th Ave Ste 100, Fairbanks, AK 99701-4768 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962011593 | Deyoung Dentistry, LLC | Clinic/Center | 2601 Boniface Parkway Suite 1, Anchorage, AK 99504 | 2020-07-29 |
| 1205461084 | Hawkinson Dental Inc | Clinic/Center | 6200 Lake Otis Pkwy Ste 101, Anchorage, AK 99507-2098 | 2020-03-11 |
| 1982238622 | Donald R Mclean | Clinic/Center | 3719 E Meridian Loop Ste B, Wasilla, AK 99654-7273 | 2020-03-02 |
| 1740745439 | Susan Olson Dmd Inc | Clinic/Center | 3261 S. Big Lake Rd. Ste D3-d4, Big Lake, AK 99652 | 2019-02-06 |
| 1932664877 | Alaska Family Dental LLC | Clinic/Center | 405 W 36th Ave Ste 101, Anchorage, AK 99503-5872 | 2019-02-05 |
| 1174016737 | Lake Road Dental LLC | Clinic/Center | 4622 Shannon Lake Rd, Dillingham, AK 99576 | 2018-06-08 |
| 1659862134 | Evelyn Haley Dmd | Clinic/Center | 615 E 82nd Ave Ste 100, Anchorage, AK 99518-3100 | 2018-05-21 |
| 1891285433 | Alaskan Family Dental Center LLC | Clinic/Center | 281 N Main St Ste 201, Wasilla, AK 99654-7046 | 2018-05-17 |
| 1376051797 | Caroline Curtis Dmd PC | Clinic/Center | 16635 Centerfield Dr Ste 207, Eagle River, AK 99577-7746 | 2018-01-19 |
| 1417475716 | Michael G. Crookston Dds PC | Clinic/Center | 11723 Old Glenn Hwy Ste 207, Eagle River, AK 99577-7750 | 2017-09-07 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FAIRBANKS ORTHODONTIC GROUP, A PROFESSIONAL CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.