Active NPI
Preston Alfred, D.D.S.
- Periodontics
- Parkersburg, WV
National Provider Identifier
1588078869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 33770
- Practice address
- 1401 Blizzard Dr
Parkersburg, WV 26101-6422 - Phone
- (304) 420-0922
- NPI assigned
- Jun 16, 2014
- Last updated
- Jan 25, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4058 | WV | |
| Periodontics | 1223P0300X | 33770 | TX | Primary |
Addresses
Primary practice location
1401 Blizzard Dr
Parkersburg, WV 26101-6422
Mailing address
7785 Eldorado Pkwy Ste 100
McKinney, TX 75070-5615
Phone (972) 569-8448
Other practice location 1
7785 Eldorado Pkwy Ste 100
McKinney, TX 75070
Phone (972) 569-8448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4058 | WV | MD | General Practice Dentistry |
| 33770 | TX | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason M. Roush D.D.S. Inc. | General Practice | Past | Accepting new patients |
| McKinney Periodontics | Periodontics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Parkersburg, WV
- NPI 1033131537
-
- Periodontics
- McKinney, TX
- NPI 1952889925
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611532800000",
"number": "1588078869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7785 ELDORADO PKWY STE 100",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750705615",
"telephone_number": "972-569-8448",
"fax_number": "214-206-8978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 BLIZZARD DR",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261016422",
"telephone_number": "304-420-0922"
}
],
"practiceLocations": [
{
"address_1": "7785 Eldorado Pkwy Ste 100",
"address_purpose": "LOCATION",
"city": "McKinney",
"state": "TX",
"postal_code": "75070",
"country_code": "US",
"telephone_number": "972-569-8448",
"fax_number": "214-206-8978",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ALFRED",
"first_name": "PRESTON",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2021-01-25",
"certification_date": "2021-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WV",
"license": "4058",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "33770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parkersburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.