Healthcare Provider Details

I. General information

NPI: 1508385253
Provider Name (Legal Business Name): ALASKA CENTER FOR CLEFT AND CRANIOFACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ARTIC BLVD STE 404
ANCHORAGE AK
99503-5769
US

IV. Provider business mailing address

3909 ARTIC BLVD STE 404
ANCHORAGE AK
99503-5769
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-5052
  • Fax: 907-222-5051
Mailing address:
  • Phone: 907-222-5052
  • Fax: 907-222-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON DASHOW
Title or Position: SURGEON
Credential: MD, DDS
Phone: 907-222-5052