Provider Demographics
NPI:1093233397
Name:SHEETS, ALICIA JOY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:JOY
Last Name:SHEETS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:JOY
Other - Last Name:MOSS , ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:807 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:CO
Mailing Address - Zip Code:80860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 HYBROOK ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-9219
Practice Address - Country:US
Practice Address - Phone:719-632-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024900124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist