Provider Demographics
NPI:1790805687
Name:PETERS, ALINA VALLECILLO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALINA
Middle Name:VALLECILLO
Last Name:PETERS
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:PO BOX 2279
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-5279
Mailing Address - Country:US
Mailing Address - Phone:252-728-2025
Mailing Address - Fax:
Practice Address - Street 1:1621 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1520
Practice Address - Country:US
Practice Address - Phone:252-728-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053OtherLICENSE NUMBER