Provider Demographics
NPI:1063530079
Name:FORD, ALFRED (DMD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 61ST ST N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-2660
Mailing Address - Country:US
Mailing Address - Phone:205-595-5361
Mailing Address - Fax:205-591-1390
Practice Address - Street 1:6 61ST ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212-2660
Practice Address - Country:US
Practice Address - Phone:205-595-5361
Practice Address - Fax:205-591-1390
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51090762OtherBLUE CROSS BLUE SHIELD