Provider Demographics
NPI:1598254062
Name:GROOMS, ALICIA CHAYNEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:CHAYNEL
Last Name:GROOMS
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 1:810 CONCORDE CIR UNIT 34222
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2963
Mailing Address - Country:US
Mailing Address - Phone:434-209-7971
Mailing Address - Fax:
Practice Address - Street 1:949 FELL ST STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3505
Practice Address - Country:US
Practice Address - Phone:410-970-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD16510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program