Provider Demographics
NPI:1275927170
Name:BELOW, ALISON BLEGEN (DMD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:BLEGEN
Last Name:BELOW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:BLEGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:W63N757 SHEBOYGAN RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1339
Mailing Address - Country:US
Mailing Address - Phone:414-708-9722
Mailing Address - Fax:
Practice Address - Street 1:1006 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4604
Practice Address - Country:US
Practice Address - Phone:414-708-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist