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General NPI Number Information
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NPI Number | 1508386616
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Entity Type | Individual
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Provider Name | BLAIRE ALFORD DMD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 380 HIGHWAY 80 E STE A
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City | CLINTON
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State | MS
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Zip | 39056-4748
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Country | US
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Telephone | 601-925-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 4978 GREEN GABLE RD
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City | TERRY
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State | MS
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Zip | 39170-8081
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Country | US
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Telephone | 601-260-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3937-17
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License Number State | MS
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