Provider Demographics
NPI:1134503428
Name:KING, ALICIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:A
Other - Last Name:CASTELLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1695 N PARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3294
Mailing Address - Country:US
Mailing Address - Phone:954-451-0265
Mailing Address - Fax:
Practice Address - Street 1:1695 N PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3294
Practice Address - Country:US
Practice Address - Phone:954-451-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21373122300000X
FLDN213731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty