Healthcare Provider Details

I. General information

NPI: 1841747250
Provider Name (Legal Business Name): CHUGACH ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
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 ROAD STE 200
ANCHORAGE AK
99507
US

V. Phone/Fax

Practice location:
  • Phone: 843-693-8901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1536
License Number StateAK

VIII. Authorized Official

Name: DR. JAMES WOOD HOWELL
Title or Position: OWNER
Credential: DMD
Phone: 843-693-8901