Provider Demographics
NPI:1376606046
Name:ALLISON, JOHN RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RALPH
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-0679
Mailing Address - Country:US
Mailing Address - Phone:479-524-3322
Mailing Address - Fax:479-524-0526
Practice Address - Street 1:113 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3153
Practice Address - Country:US
Practice Address - Phone:479-524-3322
Practice Address - Fax:479-524-0526
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice