Provider Demographics
NPI:1225235567
Name:WILLETTE, ALICIA JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:JOY
Last Name:WILLETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:EAST THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05043-4433
Mailing Address - Country:US
Mailing Address - Phone:802-785-2117
Mailing Address - Fax:802-785-3109
Practice Address - Street 1:2879 ROUTE 5
Practice Address - Street 2:
Practice Address - City:EAST THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05043-4433
Practice Address - Country:US
Practice Address - Phone:802-785-2117
Practice Address - Fax:802-785-3109
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035971223G0001X
VT016-00022751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice