Healthcare Provider Details

I. General information

NPI: 1154326452
Provider Name (Legal Business Name): ALAN VERN PICKETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROTARY WAY
VALLEJO CA
94591-8475
US

IV. Provider business mailing address

25 ROTARY WAY
VALLEJO CA
94591-8475
US

V. Phone/Fax

Practice location:
  • Phone: 707-642-2800
  • Fax: 707-642-1839
Mailing address:
  • Phone: 707-642-2800
  • Fax: 707-642-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: