| Derek Green Dmd Llc | |
|
4361 Boniface Pkwy Anchorage AK 99504-4314 | |
| (907) 333-1211 | |
| (907) 743-2925 |
| Full Name | Derek Green Dmd Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4361 Boniface Pkwy, Anchorage, Alaska |
| Authorized Official Name and Position | Derek Thomas Green (OWNER) |
| Authorized Official Contact | 4803700696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek Green Dmd Llc 4361 Boniface Pkwy Anchorage AK 99504-4314 Ph: (907) 333-1211 | Derek Green Dmd Llc 4361 Boniface Pkwy Anchorage AK 99504-4314 Ph: (907) 333-1211 |
| NPI Number | 1578130175 |
|---|---|
| Provider Enumeration Date | 06/10/2021 |
| Last Update Date | 06/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578130175 | NPI | - | NPPES |
| 1684562 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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