Provider Demographics
NPI:1154604122
Name:DOUGLASS, ALICIA (DMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MILLETT DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4099
Mailing Address - Country:US
Mailing Address - Phone:207-784-1577
Mailing Address - Fax:207-786-5214
Practice Address - Street 1:27 MILLETT DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4099
Practice Address - Country:US
Practice Address - Phone:207-784-1577
Practice Address - Fax:207-786-5214
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN42351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice