Provider Demographics
NPI:1386950624
Name:ALSTON, CHARLES NORMAN III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NORMAN
Last Name:ALSTON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. DE QUEEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832
Mailing Address - Country:US
Mailing Address - Phone:870-642-7645
Mailing Address - Fax:870-642-7655
Practice Address - Street 1:1620 GRAND AVENUE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2185
Practice Address - Country:US
Practice Address - Phone:512-670-8482
Practice Address - Fax:512-215-8154
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3903122300000X
TX357271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist