Healthcare Provider Details

I. General information

NPI: 1457842031
Provider Name (Legal Business Name): ALAN ALFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2018
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-19
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

410 VILLAGE CENTER DR
BURR RIDGE IL
60527-4513
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5717
  • Fax:
Mailing address:
  • Phone: 630-323-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDRP1833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: