Provider Demographics
NPI:1932259249
Name:ALICEA, TOMAS
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:ALICEA
Suffix:
Gender:M
Credentials:
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 201982
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-1982
Mailing Address - Country:US
Mailing Address - Phone:512-997-8614
Mailing Address - Fax:512-260-1238
Practice Address - Street 1:401 E WHITESTONE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9051
Practice Address - Country:US
Practice Address - Phone:512-260-3777
Practice Address - Fax:512-260-1238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice