Organization
ORAL SURGERY ASSOCIATES OF ALASKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM RANDY DEETER DDS (PRESIDENT)
(907) 561-1430
Entity
Organization
Contact information
Practice address
111 W 16TH AVE, SUITE 203, ANCHORAGE, AK 99501-6206
(907) 561-1430
(907) 561-2697
Mailing address
111 W 16TH AVE, SUITE 203, ANCHORAGE, AK 99501-6206
(907) 561-1430
(907) 561-2697
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18698
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518402
UNITED CON ID
AK
05
—
DDG001
—
AK
05
—
GRO153
—
AK
Enumeration date
07/28/2006
Last updated
04/10/2008
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