Healthcare Provider Details

I. General information

NPI: 1932259249
Provider Name (Legal Business Name): DR. TOMAS ALICEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E WHITESTONE BLVD
CEDAR PARK TX
78613-9051
US

IV. Provider business mailing address

PO BOX 201982
AUSTIN TX
78720-1982
US

V. Phone/Fax

Practice location:
  • Phone: 512-260-3777
  • Fax: 512-260-1238
Mailing address:
  • Phone: 512-997-8614
  • Fax: 512-260-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: