Provider Demographics
NPI:1255425294
Name:PLUMB, ALICIA JOY (DDS)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JOY
Last Name:PLUMB
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 1:2025 SE CARUTHERS ST
Mailing Address - Street 2:#7
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5465
Mailing Address - Country:US
Mailing Address - Phone:971-221-8847
Mailing Address - Fax:
Practice Address - Street 1:3653 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3034
Practice Address - Country:US
Practice Address - Phone:503-988-4410
Practice Address - Fax:503-988-5642
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice