Provider Demographics
NPI:1093540627
Name:LUCERO, ALIZZA (RDH)
Entity type:Individual
Prefix:
First Name:ALIZZA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-9778
Mailing Address - Country:US
Mailing Address - Phone:720-474-9054
Mailing Address - Fax:
Practice Address - Street 1:6436 S US HIGHWAY 85-87 STE C
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1005
Practice Address - Country:US
Practice Address - Phone:719-392-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002026338124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist