Provider Demographics
NPI:1891823209
Name:ALSTON, PAMELA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUSAN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2409
Mailing Address - Country:US
Mailing Address - Phone:510-567-5770
Mailing Address - Fax:510-633-0687
Practice Address - Street 1:2526 CASTELLO ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2103
Practice Address - Country:US
Practice Address - Phone:510-536-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice