Provider Demographics
NPI:1275891541
Name:STPAUL, ALISON (DMD, MS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:STPAUL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:ST. PAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:1705 GA 20
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-954-0072
Mailing Address - Fax:
Practice Address - Street 1:1705 HWY 20 W
Practice Address - Street 2:SUITE 200
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-954-8672
Practice Address - Fax:770-954-0074
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0152511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty