Provider Demographics
NPI:1588078869
Name:ALFRED, PRESTON (DDS)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:ALFRED
Suffix:
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 1:7785 ELDORADO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5615
Mailing Address - Country:US
Mailing Address - Phone:972-569-8448
Mailing Address - Fax:214-206-8978
Practice Address - Street 1:1401 BLIZZARD DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6422
Practice Address - Country:US
Practice Address - Phone:304-420-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40581223G0001X
TX337701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice