Provider Demographics
NPI:1134292204
Name:ABBOTT, ALLYSON ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:ANN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2605
Mailing Address - Country:US
Mailing Address - Phone:215-542-9385
Mailing Address - Fax:
Practice Address - Street 1:2050 BUTLER PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1800
Practice Address - Country:US
Practice Address - Phone:610-834-7770
Practice Address - Fax:610-834-3776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024631L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics