Provider Demographics
NPI:1164817284
Name:SCEPPAGUERCIO, ALLISON CARRIE (DMD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CARRIE
Last Name:SCEPPAGUERCIO
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 1:152 CENTRAL AVE
Mailing Address - Street 2:#202
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1115
Mailing Address - Country:US
Mailing Address - Phone:732-382-8280
Mailing Address - Fax:
Practice Address - Street 1:152 CENTRAL AVE
Practice Address - Street 2:#202
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1115
Practice Address - Country:US
Practice Address - Phone:732-382-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0390200000X
NJ22DI02618300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program