Individual
DR. WILLIAM RANDY DEETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
654
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480642
TRI-CARE ID
AK
05
—
DD0654
—
AK
Enumeration date
07/28/2006
Last updated
04/10/2008
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