Active NPI
Diedra Alston, D.D.S.
- General Practice Dentistry
- Douglassville, PA
National Provider Identifier
1578683975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25045
- Practice address
- 1139 W Benjamin Franklin Hwy
Route 422
Douglassville, PA 19518 - Phone
- (610) 385-7374
- Fax
- (610) 385-7346
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 25045 | PA | Primary |
Addresses
Primary practice location
1139 W Benjamin Franklin Hwy
Route 422
Douglassville, PA 19518
Mailing address
1139 W Benjamin Franklin Hwy
Route 422
Douglassville, PA 19518
Phone (610) 385-7374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160216000281 | PA | Order and Referring Only - Dentist | 0042514945 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25045 | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454544000000",
"number": "1578683975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1139 W BENJAMIN FRANKLIN HWY",
"address_2": "ROUTE 422",
"city": "DOUGLASSVILLE",
"state": "PA",
"postal_code": "19518",
"telephone_number": "610-385-7374",
"fax_number": "610-385-7346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1139 W BENJAMIN FRANKLIN HWY",
"address_2": "ROUTE 422",
"city": "DOUGLASSVILLE",
"state": "PA",
"postal_code": "19518",
"telephone_number": "610-385-7374",
"fax_number": "610-385-7346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALSTON",
"first_name": "DIEDRA",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2016-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "25045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglassville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.