Healthcare Provider Details

I. General information

NPI: 1942819388
Provider Name (Legal Business Name): ALYSIA NICHOLSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 DE ZAVALA RD
SAN ANTONIO TX
78249-2019
US

IV. Provider business mailing address

15506 INTERPLACE APT 5108
SAN ANTONIO TX
78249-4763
US

V. Phone/Fax

Practice location:
  • Phone: 210-690-9221
  • Fax:
Mailing address:
  • Phone: 214-284-6589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36443
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: