Provider Demographics
NPI:1528404837
Name:ELLIS, ALISON LAYNE (RDH,BS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LAYNE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RDH,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 209TH ST NE
Mailing Address - Street 2:UNIT #A
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4785
Mailing Address - Country:US
Mailing Address - Phone:360-913-4237
Mailing Address - Fax:
Practice Address - Street 1:6110 209TH ST NE
Practice Address - Street 2:UNIT #A
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4785
Practice Address - Country:US
Practice Address - Phone:360-913-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00002862124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist