SOUTH ANCHORAGE DENTAL CENTER (NPI# 1841580966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841580966 |
| Entity Type | Organization |
| Organization Name | SOUTH ANCHORAGE DENTAL CENTER |
| Practice Address |
9170 Jewel Lake Rd Ste 201 Anchorage AK 99502-5390 |
| Practice Telephone | 9072487275 |
| Practice Fax Number | 9072487221 |
| Mailing Telephone | 9072487275 |
| Mailing Fax Number | 9072487221 |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |
| Authorized Official Name | BROC WAYNE BRIMHALL (DENTIST) |
| Authorized Official Telephone | 9072487275 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | 1308 | AK | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DD0040 | 05 |
| Street Address |
9170 JEWEL LAKE RD STE 201 |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99502-5390 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386874113 | Broc Wayne Brimhall | Dentist | 9170 Jewel Lake Rd Ste 201, Anchorage, AK 99502-5390 | 2009-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073157897 | Thelma Desjarlais | Case Manager/Care Coordinator | 9201 Shorecrest Drive, Anchorage, AK 99502 | 2019-11-05 |
| 1659851038 | Vonice LLC | Pharmacy | 4311 W Lake Cir, Anchorage, AK 99502 | 2018-08-15 |
| 1447736798 | Kelly Wilson | Assisted Living Facility | 8848 Gloralee St, Anchorage, AK 99502 | 2018-07-18 |
| 1912405770 | In His Image LLC | Custodial Care Facility | 2253 Mistybrook Cir, Anchorage, AK 99502 | 2018-01-26 |
| 1316344963 | Alaska Regional Life Flight Corporation | Ambulance | 3474 Old International Airport Road, Anchorage, AK 99502 | 2014-11-25 |
| 1164827101 | Dante Kun | Counselor | 8000 West End Rd. (pt. Woronzof), Anchorage, AK 99502 | 2014-11-04 |
| 1407256357 | Kayli Ellingson | Pharmacist | 7020 Northwood Drive, 102, Anchorage, AK 99502 | 2014-08-28 |
| 1801168620 | Mckenzie Assisted Living | Clinic/Center | 8812 Hamlet Circle, 8812 Hamlet Circle, Anchorage, AK 99502 | 2012-02-09 |
| 1568623106 | South Anchorage Dental Clinic LLC | Dental Assistant | 9170 Jewel Lake Road, Suite 201, Anchorage, AK 99502 | 2008-06-17 |
| 1154580611 | Tonia Marie Taylor | Assisted Living Facility | 2821 Ruby Drive, Anchorage, AK 99502 | 2008-06-09 |
| Find all providers in zip 99502 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275067399 | Sharon Pollard-joseph | Preferred Provider Organization | 4434 E 5th Ave, Anchorage, AK 99508-2223 | 2017-04-14 |
| 1508240029 | Healthcare Consultants of Alaska,llc | Preferred Provider Organization | 3540 Perenosa Bay Dr, Anchorage, AK 99515-2352 | 2015-07-14 |
| 1841689924 | Turning Stones Care Coordination, LLC | Preferred Provider Organization | 4315 Peterkin Ave, Anchorage, AK 99508-1620 | 2015-01-13 |
| 1861839250 | Tutan Recovery Center | Preferred Provider Organization | 601 W 58th Ave Ste 140, Anchorage, AK 99518-1630 | 2013-05-27 |
| 1215198429 | Eye To Eye Assisted Living Home | Preferred Provider Organization | 3705 Artic Blvd, #1211, Anchorage, AK 99503-5774 | 2008-06-19 |
| 1326580002 | Denali Dental Care | Preferred Provider Organization | 625 E 34th Ave, Suite 200, Anchorage, AK 99503-4154 | 2016-11-10 |
| 1154744712 | Family Vision Center | Preferred Provider Organization | 3101 A St, Anchorage, AK 99503-4008 | 2014-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558618207 | Romie Joseph Deschamps IIi | Preferred Provider Organization | 15271 E Outer Springer Loop Rd, Palmer, AK 99645-9068 | 2012-08-13 |
| 1528501525 | David M Stieber Md Facc, Inc | Preferred Provider Organization | 1626 30th Ave, Suite 204, Fairbanks, AK 99701-7466 | 2016-11-22 |
| 1952652034 | There's No Place Like Home | Preferred Provider Organization | 590 N Cindy Cir, Wasilla, AK 99654-6836 | 2012-09-28 |
Please comment or provide details below to improve the information on SOUTH ANCHORAGE DENTAL CENTER.
| 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.