Healthcare Provider Details

I. General information

NPI: 1104358373
Provider Name (Legal Business Name): ABBOTT FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ABBOTT RD SUITE 102
ANCHORAGE AK
99507-3441
US

IV. Provider business mailing address

1601 ABBOTT RD SUITE 102
ANCHORAGE AK
99507-3441
US

V. Phone/Fax

Practice location:
  • Phone: 907-336-8478
  • Fax: 907-336-8873
Mailing address:
  • Phone: 907-336-8478
  • Fax: 907-336-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEND971
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDEND971
License Number StateAK

VIII. Authorized Official

Name: ROBERT P PIERSON
Title or Position: OWNER
Credential: DDS
Phone: 907-336-8478