SOUTH ANCHORAGE DENTAL CLINIC LLC (NPI# 1568623106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568623106 |
| Entity Type | Organization |
| Organization Name | SOUTH ANCHORAGE DENTAL CLINIC LLC |
| Practice Address |
9170 Jewel Lake Road Suite 201 Anchorage AK 99502 |
| Practice Telephone | 9072487275 |
| Practice Fax Number | 9072487221 |
| Mailing Telephone | 9072487275 |
| Mailing Fax Number | 9072487221 |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-06-17 |
| Authorized Official Name | SCOTT HEBERTSON (PRESIDENT) |
| Authorized Official Telephone | 9072487275 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 126800000X | Dental Assistant | 1009 | AK | Dental Providers |
| Y | 126800000X | Dental Assistant | AA625 | AK | Dental Providers |
| Street Address |
9170 JEWEL LAKE ROAD SUITE 201 |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99502 |
| 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 |
| 1154580611 | Tonia Marie Taylor | Assisted Living Facility | 2821 Ruby Drive, Anchorage, AK 99502 | 2008-06-09 |
| 1114190824 | Surgery Assistants of Alaska LLC | Clinic/Center | 9150 Jewel Lake Road Ste B, Anchorage, AK 99502 | 2008-04-03 |
| Find all providers in zip 99502 | ||||
| Taxonomy Code | 126800000X |
| Grouping | Dental Providers |
| Classification | Dental Assistant |
| An individual who may or may not have completed an accredited dental assisting education program and who aids the dentist in providing patient care services and performs other nonclinical duties in the dental office or other patient care facility. The scope of the patient care functions that may be legally delegated to the dental assistant varies based on the needs of the dentist the educational preparation of the dental assistant and state dental practice acts and regulations. Patient care services are provided under the supervision of a dentist. To avoid misleading the public, no occupational title other than dental assistant should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871133405 | Heidi Alexandra La Rocco Rocco | Dental Assistant | 330 E Tudor Rd, Anchorage, AK 99503-7369 | 2020-01-11 |
| 1548699358 | Holly Landis | Dental Assistant | 1201 N Muldoon Rd, Anchorage, AK 99504-6104 | 2013-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548809379 | Tara Marie Dillow | Dental Assistant | 354th Mdos/sgod, 2630 Central Ave Ste 1m07, Eielson Afb, AK 99702-2397 | 2019-12-26 |
| 1912359498 | Cynthia Inderrieden | Dental Assistant | Bldg 3406 Alder, Usa Dentac-ak, Attn:kamish Dental Clinic, Ft Wainwright, AK 99703-7440 | 2016-07-07 |
| 1306297056 | Christian Rodriguez | Dental Assistant | 600 Richardson Dr Bldg 634, Jber, AK 99505-8310 | 2016-06-23 |
| 1336598291 | Nikia Diggins | Dental Assistant | 600 Richardson Dr # 634, Jber, AK 99505-8310 | 2016-06-10 |
| 1649549015 | Sharon Lee Lock | Dental Assistant | 59 Punguk Street, Golovin, AK 99762 | 2011-12-14 |
| 1053695247 | Searhc | Dental Assistant | 7300 Klawock/hollis Hwy, Klawock, AK 99925-0069 | 2011-10-06 |
| 1831268218 | Amy G. Ogrinc | Dental Assistant | Building N-46 Cape Sarichef, Kodiak, AK 99619-5002 | 2006-11-07 |
| 1285610725 | Leigh C Lykins | Dental Assistant | 709 W 9th St, Ste 627, Juneau, AK 99801-1807 | 2005-12-16 |
| 1346840329 | Stephanie Danielle Rowe | Dental Assistant | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1700235546 | Tyler Tubbs | Dental Assistant | 1060 Gaffney Rd, 1055, Fort Wainwright, AK 99703-5002 | 2016-06-10 |
| Find all providers with the same taxonomy | ||||
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| 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.