Provider Demographics
NPI:1861761413
Name:ROBERT B. ALSTON, JR. D.D.S.
Entity type:Organization
Organization Name:ROBERT B. ALSTON, JR. D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-666-1366
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-0428
Mailing Address - Country:US
Mailing Address - Phone:254-666-1366
Mailing Address - Fax:254-666-4766
Practice Address - Street 1:211 SUN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3571
Practice Address - Country:US
Practice Address - Phone:254-666-1366
Practice Address - Fax:254-666-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX14148332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment