MEDICARE: DR. OMA M ALFORD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11466	TX
2	1223G0001X	General Practice Dentistry	D11466	TX

General Provider Information

NPI Number	:	1245300300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMA M ALFORD DDS

Provider Business Mailing Address
First Line	:	135 LAKEWOOD LN
Second Line	:
City	:	POTTSBORO
State	:	TX
Zip	:	75076-4679
Country	:	US
Telephone Number	:	903-908-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 LAKEWOOD LN
Second Line	:
City	:	POTTSBORO
State	:	TX
Zip	:	75076-4679
Country	:	US
Telephone Number	:	903-908-3651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	12/12/2022

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