Provider Demographics
NPI:1508410176
Name:ALFORD DENTAL, PLLC
Entity Type:Organization
Organization Name:ALFORD DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF ALFORD DENTAL, PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-975-7778
Mailing Address - Street 1:2197 MANZANITA LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5212
Mailing Address - Country:US
Mailing Address - Phone:614-975-7778
Mailing Address - Fax:
Practice Address - Street 1:6255 SHARLANDS AVE STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3729
Practice Address - Country:US
Practice Address - Phone:775-339-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty