Healthcare Provider Details

I. General information

NPI: 1548298342
Provider Name (Legal Business Name): DONALD GLENN CHILES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR DENTAL DEPT.-ALASKA NATIVE MEDICAL CENTER
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

3100 DOS CIR
ANCHORAGE AK
99507-3980
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2049
  • Fax: 907-729-2054
Mailing address:
  • Phone: 907-868-3848
  • Fax: 907-729-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1035
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: