# SOUTHCENTRAL FOUNDATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTHCENTRAL FOUNDATION
- **Other names:** Dental- ANMC OR Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1699393132
- **Legal business name:** SOUTHCENTRAL FOUNDATION
- **Authorized official:** RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
- **Authorized official phone:** (907) 729-4939

## Contact information

- **Practice address:** 4315 DIPLOMACY DR, ANCHORAGE, AK 99508-5926
- **Practice address phone:** (907) 729-2000
- **Mailing address:** PO BOX 35151, SEATTLE, WA 98124-5151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/10/2020
- **Last updated:** 09/14/2023