Provider Demographics
NPI:1437439965
Name:MONTESINOS, ALICIA MABELLA (DDS PA)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MABELLA
Last Name:MONTESINOS
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6780 W 2ND CT APT 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6774
Mailing Address - Country:US
Mailing Address - Phone:305-820-0105
Mailing Address - Fax:305-826-2663
Practice Address - Street 1:6847 W 4TH AVE
Practice Address - Street 2:6847 WEST 4 AVE
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5337
Practice Address - Country:US
Practice Address - Phone:305-820-0068
Practice Address - Fax:305-826-2663
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist