Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Derick Jack Sovereign, DMD

Individual provider Dentist · NPI 1245073287

Dr. Derick Jack Sovereign, DMD is a Dentist in Wasilla, Alaska. Practices as a sole proprietor. Licensed in Alaska.

Licensed in
AK
In the registry since
2024
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

3765 E Blue Lupine Dr Ste A
Wasilla, AK 99654-8417
Phone: (480) 341-0791
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 224623 (AK)

Record details

NPI number1245073287
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorYes
NPI enumeratedJune 17, 2024
Last updated in NPPESJune 17, 2024
Certification dateJune 17, 2024
Mailing address3765 E Blue Lupine Dr Ste A, Wasilla, AK 99654-8417

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