Provider Demographics
NPI:1477699510
Name:ALLISON, RAYMON ERIC JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMON
Middle Name:ERIC
Last Name:ALLISON
Suffix:JR
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 1:122 FT WAYNE CT
Mailing Address - Street 2:#3182
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183
Mailing Address - Country:US
Mailing Address - Phone:678-880-0725
Mailing Address - Fax:
Practice Address - Street 1:6060 MCDONOUGH DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-448-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery