Provider Demographics
NPI:1346464252
Name:JUSTIN, ALAN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:F
Last Name:JUSTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:191 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2530
Mailing Address - Country:US
Mailing Address - Phone:518-587-8777
Mailing Address - Fax:518-587-1138
Practice Address - Street 1:191 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2530
Practice Address - Country:US
Practice Address - Phone:518-587-8777
Practice Address - Fax:518-587-1138
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0300041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics