Healthcare Provider Details

I. General information

NPI: 1881140010
Provider Name (Legal Business Name): BRANDON ASTIN DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34115 STERLING HWY
ANCHOR POINT AK
99556
US

IV. Provider business mailing address

PO BOX 945
ANCHOR POINT AK
99556-0945
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-3700
  • Fax: 907-226-3702
Mailing address:
  • Phone: 907-226-3700
  • Fax: 907-226-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number110831
License Number StateAK

VIII. Authorized Official

Name: DR. BRANDON SCOTT ASTIN
Title or Position: DENTIST
Credential: DMD
Phone: 208-640-9698