Healthcare Provider Details

I. General information

NPI: 1750508727
Provider Name (Legal Business Name): PHILIP J. KLUMP,DDS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 OLD SEWARD HWY
ANCHORAGE AK
99518-2276
US

IV. Provider business mailing address

6917 OLD SEWARD HWY
ANCHORAGE AK
99518-2276
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-3633
  • Fax: 907-344-1737
Mailing address:
  • Phone: 907-522-3633
  • Fax: 907-344-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAA747
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierDDG513
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. PHILIP J KLUMP
Title or Position: OWNER
Credential: DDS
Phone: 907-522-3633