Provider Demographics
NPI:1427477306
Name:SMITH, ALICIA GALVIN (MED, RD, LD, CLT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:GALVIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, RD, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8125
Mailing Address - Country:US
Mailing Address - Phone:469-340-8449
Mailing Address - Fax:
Practice Address - Street 1:10260 N CENTRAL EXPY
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3437
Practice Address - Country:US
Practice Address - Phone:469-340-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered