Provider Demographics
NPI:1487923819
Name:ALASKA CENTER FOR DENTISTRY ANCHORAGE, PC
Entity type:Organization
Organization Name:ALASKA CENTER FOR DENTISTRY ANCHORAGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-562-2512
Mailing Address - Street 1:3708 RHONE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5000
Mailing Address - Country:US
Mailing Address - Phone:907-562-2512
Mailing Address - Fax:907-562-6080
Practice Address - Street 1:3708 RHONE CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5000
Practice Address - Country:US
Practice Address - Phone:907-562-2512
Practice Address - Fax:907-562-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9191761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty