Healthcare Provider Details

I. General information

NPI: 1568024388
Provider Name (Legal Business Name): NORTH COAST FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ABBOTT RD STE 1
ANCHORAGE AK
99507-4624
US

IV. Provider business mailing address

2020 ABBOTT RD STE 1
ANCHORAGE AK
99507
US

V. Phone/Fax

Practice location:
  • Phone: 907-344-2483
  • Fax:
Mailing address:
  • Phone: 907-344-2483
  • Fax: 907-349-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN ANN SERGIE
Title or Position: DENTIST
Credential: DMD
Phone: 907-344-2483