Provider Demographics
NPI:1528549862
Name:ALFRED, JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:ALFRED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-2610
Mailing Address - Country:US
Mailing Address - Phone:903-981-0617
Mailing Address - Fax:
Practice Address - Street 1:238 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-2610
Practice Address - Country:US
Practice Address - Phone:903-981-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34132OtherDENTAL LICENSE