Provider Demographics
NPI:1841370533
Name:ALFORD, LYNDON CRAIG (DMD)
Entity type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:CRAIG
Last Name:ALFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 NORTHPARK BLVD
Mailing Address - Street 2:BUILDING 1; SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9265
Mailing Address - Country:US
Mailing Address - Phone:843-572-1033
Mailing Address - Fax:843-572-0211
Practice Address - Street 1:8730 NORTHPARK BLVD
Practice Address - Street 2:BUILDING 1; SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9265
Practice Address - Country:US
Practice Address - Phone:843-572-1033
Practice Address - Fax:843-572-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30976Medicaid