Healthcare Provider Details

I. General information

NPI: 1265960298
Provider Name (Legal Business Name): PHILLIP MICHAEL PLOURDE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 BRIARWOOD ST STE 201
ANCHORAGE AK
99518-3333
US

IV. Provider business mailing address

8301 BRIARWOOD ST STE 201
ANCHORAGE AK
99518-3333
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-6522
  • Fax: 907-349-9850
Mailing address:
  • Phone: 907-349-6522
  • Fax: 907-349-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number148425
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009737
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: