Provider Demographics
NPI:1063231488
Name:DUCLOS ORTHO ANCHORAGE
Entity type:Organization
Organization Name:DUCLOS ORTHO ANCHORAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUCLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-272-3200
Mailing Address - Street 1:1836 W NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3342
Mailing Address - Country:US
Mailing Address - Phone:907-272-3200
Mailing Address - Fax:907-272-3202
Practice Address - Street 1:1836 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3342
Practice Address - Country:US
Practice Address - Phone:907-272-3200
Practice Address - Fax:907-272-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty