Provider Demographics
NPI:1073696498
Name:FIRESTONE, ALAN H (DMD,PC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:FIRESTONE
Suffix:
Gender:M
Credentials:DMD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-347-3322
Mailing Address - Fax:
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-347-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019220-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry