MEDICARE: DR. ALICIA JOY WILLETTE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	03597	NH
2	1223G0001X	General Practice Dentistry	016-0002275	VT

General Provider Information

NPI Number	:	1225235567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA JOY WILLETTE DDS

Provider Business Mailing Address
First Line	:	2879 ROUTE 5
Second Line	:
City	:	EAST THETFORD
State	:	VT
Zip	:	05043-4433
Country	:	US
Telephone Number	:	802-785-2117
Fax Number	:	802-785-3109

Provider Business Practice Location Address
First Line	:	2879 ROUTE 5
Second Line	:
City	:	EAST THETFORD
State	:	VT
Zip	:	05043-4433
Country	:	US
Telephone Number	:	802-785-2117
Fax Number	:	802-785-3109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	08/14/2020

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