Healthcare Provider Details

I. General information

NPI: 1831550631
Provider Name (Legal Business Name): FAIRBANKS DENTAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 AIRPORT WAY SUITE 1
FAIRBANKS AK
99709-4768
US

IV. Provider business mailing address

3112 AIRPORT WAY STE 1
FAIRBANKS AK
99709-4768
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-1250
  • Fax: 907-456-1307
Mailing address:
  • Phone: 907-452-1250
  • Fax: 907-456-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTEN LEIGH WHETSELL
Title or Position: OWNER
Credential: DDS
Phone: 907-452-1250