Provider Demographics
NPI:1518254317
Name:FETNER, ALEXANDER J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:J
Last Name:FETNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 SOUTHPOINT PKWY S STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8742
Mailing Address - Country:US
Mailing Address - Phone:904-296-8343
Mailing Address - Fax:
Practice Address - Street 1:7043 SOUTHPOINT PKWY S STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-296-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN196141223P0300X
FL196141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty