Healthcare Provider Details

I. General information

NPI: 1033421045
Provider Name (Legal Business Name): ANTONIO S PARAMESWARAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ABBOTT RD STE 200
ANCHORAGE AK
99507-3878
US

IV. Provider business mailing address

2000 ABBOTT RD STE 200
ANCHORAGE AK
99507-3878
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-9939
  • Fax:
Mailing address:
  • Phone: 907-602-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD1343
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: