Provider Demographics
NPI:1033325105
Name:WAYNE PALESTINI DMD PC
Entity Type:Organization
Organization Name:WAYNE PALESTINI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT OF WAYNE PALESTIN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PALESTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-781-3681
Mailing Address - Street 1:1029 35TH ST WEST ENSLEY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-781-3681
Mailing Address - Fax:205-781-3682
Practice Address - Street 1:1029 35TH ST WEST ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-781-3681
Practice Address - Fax:205-781-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2636261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental