MEDICARE: ALAN TODD WAKEFIELD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN30839	FL

General Provider Information

NPI Number	:	1790843613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN TODD WAKEFIELD D.D.S.

Provider Business Mailing Address
First Line	:	7385 PARK VILLAGE DR APT 3406
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-8026
Country	:	US
Telephone Number	:	415-605-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4803
Country	:	US
Telephone Number	:	904-240-1941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	02/10/2026

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