Provider Demographics
NPI:1245300300
Name:ALFORD, OMA M (DDS)
Entity type:Individual
Prefix:DR
First Name:OMA
Middle Name:M
Last Name:ALFORD
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 1:135 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-4679
Mailing Address - Country:US
Mailing Address - Phone:903-908-3651
Mailing Address - Fax:
Practice Address - Street 1:135 LAKEWOOD LN
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-4679
Practice Address - Country:US
Practice Address - Phone:903-908-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114661223G0001X
TXD114661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice