Provider Demographics
NPI:1093801490
Name:ALFORD, TAMEKO LASHON (DDS)
Entity Type:Individual
Prefix:
First Name:TAMEKO
Middle Name:LASHON
Last Name:ALFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 W HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6430
Mailing Address - Country:US
Mailing Address - Phone:704-853-5048
Mailing Address - Fax:704-671-1404
Practice Address - Street 1:420 N SALISBURY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3548
Practice Address - Country:US
Practice Address - Phone:843-448-3810
Practice Address - Fax:843-445-9206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902JCMedicaid
SCZX3874Medicaid