Provider Demographics
NPI:1306205174
Name:ALEXANDER W. ALLRED, DMD PLLC
Entity Type:Organization
Organization Name:ALEXANDER W. ALLRED, DMD PLLC
Other - Org Name:OAK RIDGE DENTAL ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-279-7774
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0338
Mailing Address - Country:US
Mailing Address - Phone:704-279-7774
Mailing Address - Fax:
Practice Address - Street 1:208 BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-8896
Practice Address - Country:US
Practice Address - Phone:704-279-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty