Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS-019220-L | PA |
NPI | 1073696498 |
---|---|
Provider Name | Dr. Alan H Firestone |
First Address | Scranton, PA 18510-2025 |
Second Address | Scranton, PA 18510-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 08/07/2007 |