Provider Demographics
NPI:1952158842
Name:RICALDE, ALINA RENEE (DDS)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:RENEE
Last Name:RICALDE
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 1:11095 POPLAR ST APT D
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2939
Mailing Address - Country:US
Mailing Address - Phone:909-227-3800
Mailing Address - Fax:
Practice Address - Street 1:1895 ORANGE TREE LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0111
Practice Address - Country:US
Practice Address - Phone:909-328-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist