Provider Demographics
NPI:1285292011
Name:ACD1, LLC
Entity type:Organization
Organization Name:ACD1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-336-1234
Mailing Address - Street 1:3340 PROVIDENCE DR STE 552
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4643
Mailing Address - Country:US
Mailing Address - Phone:907-336-1234
Mailing Address - Fax:907-336-4321
Practice Address - Street 1:3340 PROVIDENCE DR STE 552
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4643
Practice Address - Country:US
Practice Address - Phone:907-336-1234
Practice Address - Fax:907-336-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty