Healthcare Provider Details

I. General information

NPI: 1245300300
Provider Name (Legal Business Name): OMA M ALFORD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/12/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 LAKEWOOD LN
POTTSBORO TX
75076-4679
US

IV. Provider business mailing address

135 LAKEWOOD LN
POTTSBORO TX
75076-4679
US

V. Phone/Fax

Practice location:
  • Phone: 903-908-3651
  • Fax:
Mailing address:
  • Phone: 903-908-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11466
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: