Provider Demographics
NPI:1629255799
Name:REDFEARN, ALEC FLOYD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:FLOYD
Last Name:REDFEARN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064
Mailing Address - Country:US
Mailing Address - Phone:386-362-1646
Mailing Address - Fax:386-362-6167
Practice Address - Street 1:931 NORTH OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064
Practice Address - Country:US
Practice Address - Phone:386-362-1646
Practice Address - Fax:386-362-6167
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice