Provider Demographics
NPI:1497828610
Name:FORTIER, ALICE CROWLEY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:CROWLEY
Last Name:FORTIER
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 1:300 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7131
Mailing Address - Country:US
Mailing Address - Phone:910-251-8174
Mailing Address - Fax:910-341-3037
Practice Address - Street 1:1624 PRINCESS ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3848
Practice Address - Country:US
Practice Address - Phone:910-251-8174
Practice Address - Fax:910-341-3037
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1731124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist