Provider Demographics
NPI:1972712735
Name:ALSTON, DOUGLAS P (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:ALSTON
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 1:4518 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1221
Mailing Address - Country:US
Mailing Address - Phone:323-293-5223
Mailing Address - Fax:323-293-5224
Practice Address - Street 1:4518 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1221
Practice Address - Country:US
Practice Address - Phone:323-293-5223
Practice Address - Fax:323-293-5224
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD247391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice