Provider Demographics
NPI:1285071795
Name:BIBEAU, ALICIA MICHELLE (LDH)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:LDH
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:BIBEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDH
Mailing Address - Street 1:1670 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1201
Mailing Address - Country:US
Mailing Address - Phone:651-925-8400
Mailing Address - Fax:651-925-8434
Practice Address - Street 1:1670 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1201
Practice Address - Country:US
Practice Address - Phone:651-925-8400
Practice Address - Fax:651-925-8434
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH8128124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist