MEDICARE: DR. ALLA FESTINA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02070300	NJ
2	122300000X	Dentist	22DI02070300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922025675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLA FESTINA DDS

Provider Business Mailing Address
First Line	:	301 PROSPECT AVE
Second Line	:
City	:	PINE BEACH
State	:	NJ
Zip	:	08741-1044
Country	:	US
Telephone Number	:	732-341-1200
Fax Number	:	732-557-4542

Provider Business Practice Location Address
First Line	:	301 PROSPECT AVE
Second Line	:
City	:	PINE BEACH
State	:	NJ
Zip	:	08741-1044
Country	:	US
Telephone Number	:	732-341-1200
Fax Number	:	732-557-4542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/04/2010

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