=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790805687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALINA VALLECILLO PETERS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 LIVE OAK ST
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28516-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-728-2025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 LIVE OAK ST
-----------------------------------------------------
City | BEAUFORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28516-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-728-2025
-----------------------------------------------------
Fax | 252-728-3326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8053
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------