Provider Demographics
NPI:1942819388
Name:NICHOLSON, ALYSIA (DDS)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:NICHOLSON
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 1:5650 WORTH PKWY APT 2107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1509
Mailing Address - Country:US
Mailing Address - Phone:214-284-6589
Mailing Address - Fax:
Practice Address - Street 1:20821 US HIGHWAY 281 N STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7597
Practice Address - Country:US
Practice Address - Phone:210-494-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice