Provider Demographics
NPI:1619972460
Name:BRIAN, ALFRED THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:THOMAS
Last Name:BRIAN
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 1:720 E MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3105
Mailing Address - Country:US
Mailing Address - Phone:972-727-5001
Mailing Address - Fax:972-727-6335
Practice Address - Street 1:720 E MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3105
Practice Address - Country:US
Practice Address - Phone:972-727-5001
Practice Address - Fax:972-727-6335
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice