Basic Information
| Provider Information | |||||||||
| NPI: | 1790843613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAKEFIELD | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | TODD | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CAPTAIN DR | ||||||||
| Address2: | #E234 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152868067 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2813 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152857500 | ||||||||
| FaxNumber: | 4156429847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 41146 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.