Healthcare Provider Details

I. General information

NPI: 1437711256
Provider Name (Legal Business Name): DEXTER ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 08/11/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number236799
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: