Provider Demographics
NPI:1649073586
Name:ALDACA, KRYSTAL MAE DEL ROSARIO (DDS)
Entity type:Individual
Prefix:
First Name:KRYSTAL MAE
Middle Name:DEL ROSARIO
Last Name:ALDACA
Suffix:
Gender:
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 6982
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6982
Mailing Address - Country:US
Mailing Address - Phone:671-686-0823
Mailing Address - Fax:
Practice Address - Street 1:140 PUNZALAN ST
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3441
Practice Address - Country:US
Practice Address - Phone:671-646-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD1057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist