Healthcare Provider Details

I. General information

NPI: 1538152046
Provider Name (Legal Business Name): ALSTON J. MCCASLIN VI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ABERCORN ST
SAVANNAH GA
31405-5509
US

IV. Provider business mailing address

5901 ABERCORN ST
SAVANNAH GA
31405-5509
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-5901
  • Fax: 912-355-0735
Mailing address:
  • Phone: 912-355-5901
  • Fax: 912-355-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11508
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier800722
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerUNITED CONCORDIA I.D.#
# 2
IdentifierZG1508
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: