Provider Demographics
NPI:1144360306
Name:ALSTON, DENISE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNN
Last Name:ALSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 NOLL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-7602
Mailing Address - Country:US
Mailing Address - Phone:717-522-1083
Mailing Address - Fax:717-397-6057
Practice Address - Street 1:2135 NOLL DR
Practice Address - Street 2:SUITE C
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7602
Practice Address - Country:US
Practice Address - Phone:717-397-7625
Practice Address - Fax:717-397-6057
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD50356501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008214910002Medicaid