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General NPI Number Information
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NPI Number | 1033325105
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Entity Type | Organization
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Legal Business Name | WAYNE PALESTINI DMD PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1029 35TH ST WEST ENSLEY
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City | BIRMINGHAM
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State | AL
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Zip | 35216
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Country | US
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Telephone | 205-781-3681
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Fax | 205-781-3682
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Provider Business Mailing Address
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Address Line | 1029 35TH ST WEST ENSLEY
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City | BIRMINGHAM
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State | AL
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Zip | 35216
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Country | US
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Telephone | 205-781-3681
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Fax | 205-781-3682
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Authorized Official
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Title or Position | DENTIST PRESIDENT OF WAYNE PALESTIN
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Name | DR. FREDERICK WAYNE PALESTINI
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Credential | DMD
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Telephone | 205-781-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2636
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License Number State | AL
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