Provider Demographics
NPI:1548572761
Name:ANDREW WAPPETT D.M.D. P.C.
Entity type:Organization
Organization Name:ANDREW WAPPETT D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WAPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-456-8100
Mailing Address - Street 1:1131 SADLER WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3171
Mailing Address - Country:US
Mailing Address - Phone:907-456-8100
Mailing Address - Fax:907-318-6999
Practice Address - Street 1:1131 SADLER WAY
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3171
Practice Address - Country:US
Practice Address - Phone:907-456-8100
Practice Address - Fax:907-318-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD1276Medicaid