Provider Demographics
NPI:1639312622
Name:GITTLEMAN, ALICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:GITTLEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:327 LOUDON ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-230-9719
Mailing Address - Fax:603-410-6754
Practice Address - Street 1:CARING FAMILY DENTISTRY PLLC
Practice Address - Street 2:327 LOUDON RD
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-230-9719
Practice Address - Fax:603-410-6754
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236354Medicaid