Provider Demographics
NPI:1356436521
Name:ALCALA, CARMEN MILAGROS (DMD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MILAGROS
Last Name:ALCALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FORTY ACRE LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2114
Mailing Address - Country:US
Mailing Address - Phone:802-878-0979
Mailing Address - Fax:
Practice Address - Street 1:300 CORNERSTONE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4012
Practice Address - Country:US
Practice Address - Phone:802-878-7775
Practice Address - Fax:802-879-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00011751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0448Medicaid