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General NPI Number Information
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NPI Number | 1053642264
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Entity Type | Organization
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Legal Business Name | FETNER AND HARTIGAN, PERIODONTICS
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 7043 SOUTHPOINT PKWY STE B
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8742
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Country | US
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Telephone | 904-296-8343
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Fax | 904-296-8663
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Provider Business Mailing Address
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Address Line | 7043 SOUTHPOINT PKWY S STE B
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8712
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Country | US
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Telephone | 904-296-8343
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Fax | 904-296-8663
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ALAN E. FETNER
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Credential | D.M.D.
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Telephone | 904-296-8343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN8387
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License Number State | FL
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