Provider Demographics
NPI:1073292132
Name:LO, ALICIA TZU-TING (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:TZU-TING
Last Name:LO
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 1:816 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4751
Mailing Address - Country:US
Mailing Address - Phone:510-320-4392
Mailing Address - Fax:
Practice Address - Street 1:46921 WARM SPRINGS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7934
Practice Address - Country:US
Practice Address - Phone:510-792-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist