Provider Demographics
NPI:1003123605
Name:BURGE, ALESIA NICOLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALESIA
Middle Name:NICOLA
Last Name:BURGE
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 1:2100 DIXWELL AVE
Mailing Address - Street 2:SUITE 64
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2406
Mailing Address - Country:US
Mailing Address - Phone:203-288-3000
Mailing Address - Fax:203-288-3004
Practice Address - Street 1:2100 DIXWELL AVE
Practice Address - Street 2:SUITE 64
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2406
Practice Address - Country:US
Practice Address - Phone:203-288-3000
Practice Address - Fax:203-288-3004
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice