Provider Demographics
NPI:1942789110
Name:ATES, ALICIA DIANE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DIANE
Last Name:ATES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:DIANE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3709 W 154TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3862
Mailing Address - Country:US
Mailing Address - Phone:903-277-9555
Mailing Address - Fax:979-776-1048
Practice Address - Street 1:3001 WILDFLOWER DRIVE
Practice Address - Street 2:SUITE #511
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-1040
Practice Address - Fax:979-776-1048
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34476122300000X
KS619361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist