Provider Demographics
NPI:1982270849
Name:SUAREZ, ALICIA VIVIANA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:VIVIANA
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 BUFORD HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3379
Mailing Address - Country:US
Mailing Address - Phone:678-768-1198
Mailing Address - Fax:
Practice Address - Street 1:3195 BUFORD HWY STE 3
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3379
Practice Address - Country:US
Practice Address - Phone:678-768-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DH008372124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist