Provider Demographics
NPI:1427271717
Name:FISTEL, ALAN TERRY (D M D)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:TERRY
Last Name:FISTEL
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7522 WILES RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2062
Mailing Address - Country:US
Mailing Address - Phone:954-755-7971
Mailing Address - Fax:954-755-7994
Practice Address - Street 1:7522 WILES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2062
Practice Address - Country:US
Practice Address - Phone:954-755-7971
Practice Address - Fax:954-755-7994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice