Provider Demographics
NPI:1508386616
Name:ALFORD, BLAIRE (DMD)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4978 GREEN GABLE RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-8081
Mailing Address - Country:US
Mailing Address - Phone:601-260-2772
Mailing Address - Fax:
Practice Address - Street 1:380 HIGHWAY 80 E STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4748
Practice Address - Country:US
Practice Address - Phone:601-925-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3937-171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice