MEDICARE: DR. DOUGLAS P ALSTON 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	D24739	CA

General Provider Information

NPI Number	:	1972712735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS P ALSTON D.D.S

Provider Business Mailing Address
First Line	:	4518 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1221
Country	:	US
Telephone Number	:	323-293-5223
Fax Number	:	323-293-5224

Provider Business Practice Location Address
First Line	:	4518 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1221
Country	:	US
Telephone Number	:	323-293-5223
Fax Number	:	323-293-5224

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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