Provider Demographics
NPI:1144769183
Name:GOLDSMITH, ALECIA DANIELLE (RDH)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:DANIELLE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ALECIA
Other - Middle Name:DANIELLE
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:819 NW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6010
Mailing Address - Country:US
Mailing Address - Phone:405-517-8935
Mailing Address - Fax:
Practice Address - Street 1:819 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6010
Practice Address - Country:US
Practice Address - Phone:405-517-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2920124Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No124Q00000XDental ProvidersDental Hygienist