Provider Demographics
NPI:1760897714
Name:MICKLES, ALICIA JAMELLE (DDS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JAMELLE
Last Name:MICKLES
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 1:6140 UNIVERSITY DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1772
Mailing Address - Country:US
Mailing Address - Phone:256-285-3420
Mailing Address - Fax:
Practice Address - Street 1:6140 UNIVERSITY DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1772
Practice Address - Country:US
Practice Address - Phone:256-285-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025418122300000X
ALD.007173-C122300000X
CT11769122300000X
TN10030122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program