Healthcare Provider Details

I. General information

NPI: 1972483261
Provider Name (Legal Business Name): ALICIA CARLA GUMBS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W LINCOLN ST
EASTON PA
18042
US

IV. Provider business mailing address

740 W GRANT ST
EASTON PA
18042-7352
US

V. Phone/Fax

Practice location:
  • Phone: 484-664-9598
  • Fax:
Mailing address:
  • Phone: 917-232-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH076116
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: