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General NPI Number Information
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NPI Number | 1124741178
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Entity Type | Individual
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Provider Name | ALETHEA GRACE FEI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 5725 MALDEN RD
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City | LASALLE
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State | ONTARIO
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Zip | N9H1R9
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Country | CA
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Telephone | 519-966-1616
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Fax |
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Provider Business Mailing Address
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Address Line | 5991 CAMEOS CRES
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City | LASALLE
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State | ONTARIO
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Zip | N9J 3N3
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DENT.DE.61353893
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License Number State | WA
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