Provider Demographics
NPI:1508152067
Name:KONICK, ALLISON (DMD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KONICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 STATE ROAD 70 EAST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-1307
Mailing Address - Country:US
Mailing Address - Phone:941-953-5565
Mailing Address - Fax:813-336-0836
Practice Address - Street 1:11155 STATE ROAD 70 EAST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-953-5565
Practice Address - Fax:813-336-0836
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL193861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice