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General NPI Number Information
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NPI Number | 1750524765
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Entity Type | Individual
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Provider Name | LEROY BERTRAM ALFORD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 10 LEGACY WAY SUITE C
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City | ADAIRSVILLE
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State | GA
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Zip | 30103-2461
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Country | US
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Telephone | 770-773-7227
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Fax | 706-291-0684
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Provider Business Mailing Address
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Address Line | PO BOX 106
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City | ROME
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State | GA
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Zip | 30162-0106
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Country | US
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Telephone | 770-773-7227
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Fax | 706-291-0684
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 008829
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License Number State | GA
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