MEDICARE: DR. GEORGE ROBERT ALFORD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	015958	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B15958 01	OTHER	TX	TEXAS C.H.I.P.S. PROVDER

General Provider Information

NPI Number	:	1316058761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ROBERT ALFORD D.D.S.

Provider Business Mailing Address
First Line	:	5511 AUSTIN ST STE 2C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7144
Country	:	US
Telephone Number	:	713-523-6344
Fax Number	:	713-524-2896

Provider Business Practice Location Address
First Line	:	5511 AUSTIN ST STE 2C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7144
Country	:	US
Telephone Number	:	713-523-6344
Fax Number	:	713-524-2896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/09/2007

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