Healthcare Provider Details

I. General information

NPI: 1649338393
Provider Name (Legal Business Name): PHILLIP VAUGHN MORITZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WILLOUGHBY AVE STE 208
JUNEAU AK
99801
US

IV. Provider business mailing address

400 WILLOUGHBY AVE STE 208
JUNEAU AK
99801
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-1385
  • Fax:
Mailing address:
  • Phone: 907-586-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberAK0450
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAK0450
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: