Provider Demographics
NPI:1942298047
Name:ABEYTA, ALICIA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:ABEYTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 BEVERLY HILLS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3606
Mailing Address - Country:US
Mailing Address - Phone:505-353-1184
Mailing Address - Fax:
Practice Address - Street 1:5901 WYOMING BLVD NE STE Q
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3859
Practice Address - Country:US
Practice Address - Phone:505-585-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist