Provider Demographics
NPI:1578054862
Name:TURCOTTE, ALICIA TAVARES
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:TAVARES
Last Name:TURCOTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WATER ST
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:MA
Mailing Address - Zip Code:02769-1705
Mailing Address - Country:US
Mailing Address - Phone:508-463-7334
Mailing Address - Fax:
Practice Address - Street 1:366 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769-1816
Practice Address - Country:US
Practice Address - Phone:508-252-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858000122300000X
390200000X
RIDEN03383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program