Provider Demographics
NPI:1790843613
Name:WAKEFIELD, ALAN TODD (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:TODD
Last Name:WAKEFIELD
Suffix:
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 1:6 CAPTAIN DR
Mailing Address - Street 2:#E234
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1742
Mailing Address - Country:US
Mailing Address - Phone:415-286-8067
Mailing Address - Fax:
Practice Address - Street 1:2813 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3907
Practice Address - Country:US
Practice Address - Phone:415-285-7500
Practice Address - Fax:415-642-9847
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice