Healthcare Provider Details

I. General information

NPI: 1649713074
Provider Name (Legal Business Name): DARIN ANDERSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DIMOND BLVD STE 3-600
ANCHORAGE AK
99515-2045
US

IV. Provider business mailing address

800 E DIMOND BLVD STE 3-600
ANCHORAGE AK
99515-2045
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-3636
  • Fax: 907-349-7027
Mailing address:
  • Phone: 907-349-3636
  • Fax: 907-349-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1445
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1445
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerALASKA

VIII. Authorized Official

Name: DARIN N ANDERSON
Title or Position: OWNER
Credential: DMD
Phone: 907-349-3636