Provider Demographics
NPI:1265867279
Name:SUIT, ALLYSON RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:RAE
Last Name:SUIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALLYSON
Other - Middle Name:RAE
Other - Last Name:WOLFERSTEIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1264 PALM COAST PKWY SW
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4700
Mailing Address - Country:US
Mailing Address - Phone:386-283-4902
Mailing Address - Fax:
Practice Address - Street 1:1264 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4700
Practice Address - Country:US
Practice Address - Phone:904-283-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 203911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice