Provider Demographics
NPI:1134568470
Name:HOUSTON, ALICIA M (DDS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:HOUSTON
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 1:1009 E STREET SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-547-2491
Mailing Address - Fax:202-547-3573
Practice Address - Street 1:1009 E ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2847
Practice Address - Country:US
Practice Address - Phone:202-547-2491
Practice Address - Fax:202-547-3673
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCDEN1001461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program