Provider Demographics
NPI:1578546404
Name:FINE, ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:FINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:24318 WALNUT ST
Mailing Address - Street 2:STE 2 2ND FLOOR
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2924
Mailing Address - Country:US
Mailing Address - Phone:661-259-7760
Mailing Address - Fax:661-259-8096
Practice Address - Street 1:24318 WALNUT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2924
Practice Address - Country:US
Practice Address - Phone:661-259-7760
Practice Address - Fax:661-259-8096
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist