Provider Demographics
NPI:1023367257
Name:ALSBURY DENTAL
Entity Type:Organization
Organization Name:ALSBURY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-295-3070
Mailing Address - Street 1:699 NE ALSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2660
Mailing Address - Country:US
Mailing Address - Phone:817-295-3070
Mailing Address - Fax:817-295-3250
Practice Address - Street 1:699 NE ALSBURY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2660
Practice Address - Country:US
Practice Address - Phone:817-295-3070
Practice Address - Fax:817-295-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty