Provider Demographics
NPI:1457019390
Name:ALFORD, TYLER (RDH)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ALFORD
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 CHOKEBERRY PL APT 4
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-6032
Mailing Address - Country:US
Mailing Address - Phone:915-637-1785
Mailing Address - Fax:
Practice Address - Street 1:THEODORE ROOSEVELT
Practice Address - Street 2:CVN 71
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96632
Practice Address - Country:US
Practice Address - Phone:360-627-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24761124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist