Organization
SOUTH ANCHORAGE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROC WAYNE BRIMHALL DMD (DENTIST)
(907) 248-7275
Entity
Organization
Contact information
Practice address
9170 JEWEL LAKE RD STE 201, ANCHORAGE, AK 99502-5390
(907) 248-7275
(907) 248-7221
Mailing address
9170 JEWEL LAKE RD STE 201, ANCHORAGE, AK 99502-5390
(907) 248-7275
(907) 248-7221
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
1308
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0040
—
AK
Enumeration date
04/11/2011
Last updated
04/11/2011
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