Provider Demographics
NPI:1033440177
Name:GREGG A ALFORD DMD PA
Entity Type:Organization
Organization Name:GREGG A ALFORD DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PA
Authorized Official - Phone:501-525-3266
Mailing Address - Street 1:3812 CENTRAL AVE
Mailing Address - Street 2:SUITE I & J
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6944
Mailing Address - Country:US
Mailing Address - Phone:501-525-3266
Mailing Address - Fax:501-525-7180
Practice Address - Street 1:3812 CENTRAL AVE
Practice Address - Street 2:SUITE I & J
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6944
Practice Address - Country:US
Practice Address - Phone:501-525-3266
Practice Address - Fax:501-525-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2893261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116312608Medicaid