Provider Demographics
NPI:1336698596
Name:ALFORD, JESSICA ARNEE (DDS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARNEE
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 1:609 BEAVER RUIN RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3401
Mailing Address - Country:US
Mailing Address - Phone:678-606-9407
Mailing Address - Fax:
Practice Address - Street 1:200 E PONCE DE LEON AVE STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3469
Practice Address - Country:US
Practice Address - Phone:678-836-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015297122300000X
GADNO152971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist