Healthcare Provider Details

I. General information

NPI: 1588280846
Provider Name (Legal Business Name): ALEXANDRIA NICOLE CARRILLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8567 N SILVERBELL RD STE 101
TUCSON AZ
85743-7111
US

IV. Provider business mailing address

8567 N SILVERBELL RD STE 101
TUCSON AZ
85743-7111
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-2663
  • Fax: 520-744-9093
Mailing address:
  • Phone: 520-744-2663
  • Fax: 520-744-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD010858
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: