Provider Demographics
NPI:1215010012
Name:ALLISON, OWEN WORTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:WORTH
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9596
Mailing Address - Country:US
Mailing Address - Phone:717-684-3943
Mailing Address - Fax:717-684-3110
Practice Address - Street 1:100 S 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9596
Practice Address - Country:US
Practice Address - Phone:717-684-3943
Practice Address - Fax:717-684-3110
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020429L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist