Healthcare Provider Details

I. General information

NPI: 1871876029
Provider Name (Legal Business Name): MARY ALFORD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 HAWTHORNE ST
HOUSTON TX
77006-3711
US

IV. Provider business mailing address

1429 HAWTHORNE ST
HOUSTON TX
77006-3711
US

V. Phone/Fax

Practice location:
  • Phone: 713-341-3790
  • Fax: 713-524-7995
Mailing address:
  • Phone: 713-529-6071
  • Fax: 713-529-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15283
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: