Healthcare Provider Details

I. General information

NPI: 1144320474
Provider Name (Legal Business Name): LUIS F ALICEA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7352 STONEROCK CIR SUITE A
ORLANDO FL
32819-8000
US

IV. Provider business mailing address

7352 STONEROCK CIR SUITE A
ORLANDO FL
32819-8000
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-0575
  • Fax: 407-363-6945
Mailing address:
  • Phone: 407-351-0575
  • Fax: 407-363-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDN16121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: