Provider Demographics
NPI:1518223536
Name:JANSSENS, ALICIA LYNN (RDH)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:LYNN
Last Name:JANSSENS
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 1:2114 W CLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1615
Mailing Address - Country:US
Mailing Address - Phone:714-743-6644
Mailing Address - Fax:
Practice Address - Street 1:2114 W CLOVER AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1615
Practice Address - Country:US
Practice Address - Phone:714-743-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26331124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist