MEDICARE: DUCLOS ORTHO ANCHORAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1063231488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUCLOS ORTHO ANCHORAGE

Provider Business Mailing Address
First Line	:	1836 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-3342
Country	:	US
Telephone Number	:	907-272-3200
Fax Number	:	907-272-3202

Provider Business Practice Location Address
First Line	:	1836 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-3342
Country	:	US
Telephone Number	:	907-272-3200
Fax Number	:	907-272-3202

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. JACK B DUCLOS
Credential	:	DDS
Telephone Number	:	907-272-3200

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/03/2024

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Directions to “DUCLOS ORTHO ANCHORAGE ” Practice Location

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