Healthcare Provider Details

I. General information

NPI: 1720135999
Provider Name (Legal Business Name): CHRISTINE A ROALOFS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MULDOON RD
ANCHORAGE AK
99504-2030
US

IV. Provider business mailing address

700 MULDOON RD
ANCHORAGE AK
99504-2030
US

V. Phone/Fax

Practice location:
  • Phone: 907-333-5437
  • Fax:
Mailing address:
  • Phone: 907-333-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1003
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierDD10036
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
IdentifierDD10035
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 3
IdentifierDD10032
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 4
IdentifierDD10033
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 5
IdentifierDD10034
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: