Provider Demographics
NPI:1326748302
Name:CHRISTIAN, ALISHA (RDH)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 JOHNSON DAIRY RD APT 662
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6739
Mailing Address - Country:US
Mailing Address - Phone:917-239-1563
Mailing Address - Fax:
Practice Address - Street 1:10625 N MILITARY TRL STE 201
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6548
Practice Address - Country:US
Practice Address - Phone:561-366-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH070677124Q00000X
FLDH26143124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist