Healthcare Provider Details

I. General information

NPI: 1033325105
Provider Name (Legal Business Name): WAYNE PALESTINI DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 35TH ST WEST ENSLEY
BIRMINGHAM AL
35216
US

IV. Provider business mailing address

1029 35TH ST WEST ENSLEY
BIRMINGHAM AL
35216
US

V. Phone/Fax

Practice location:
  • Phone: 205-781-3681
  • Fax: 205-781-3682
Mailing address:
  • Phone: 205-781-3681
  • Fax: 205-781-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2636
License Number StateAL

VIII. Authorized Official

Name: DR. FREDERICK WAYNE PALESTINI
Title or Position: DENTIST PRESIDENT OF WAYNE PALESTIN
Credential: DMD
Phone: 205-781-3681