Healthcare Provider Details

I. General information

NPI: 1841533155
Provider Name (Legal Business Name): KEVIN M EASLEY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E TUDOR RD
ANCHORAGE AK
99503-7369
US

IV. Provider business mailing address

330 E TUDOR RD
ANCHORAGE AK
99503-7369
US

V. Phone/Fax

Practice location:
  • Phone: 907-248-0022
  • Fax: 907-206-3905
Mailing address:
  • Phone: 907-248-0022
  • Fax: 907-677-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number994
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN M EASLEY
Title or Position: PRESIDENT
Credential: DMD
Phone: 907-248-0022