Provider Demographics
NPI:1124181896
Name:ALSTON, ROBERT BAILEY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BAILEY
Last Name:ALSTON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SUN VALLEY BLVD
Mailing Address - Street 2:P.O. BOX 428
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3571
Mailing Address - Country:US
Mailing Address - Phone:254-666-1366
Mailing Address - Fax:245-666-4766
Practice Address - Street 1:211 SUN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3571
Practice Address - Country:US
Practice Address - Phone:254-666-1366
Practice Address - Fax:245-666-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice