Healthcare Provider Details

I. General information

NPI: 1073696498
Provider Name (Legal Business Name): ALAN H FIRESTONE D.M.D.,P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ADAMS AVE SUITE 301
SCRANTON PA
18510-2025
US

IV. Provider business mailing address

401 ADAMS AVE SUITE 301
SCRANTON PA
18510-2025
US

V. Phone/Fax

Practice location:
  • Phone: 570-347-3322
  • Fax:
Mailing address:
  • Phone: 570-347-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS-019220-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: