Provider Demographics
NPI:1568780906
Name:DOUGLAS, ALLISON (DMD)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:
Last Name:DOUGLAS
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 1:295 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-3024
Mailing Address - Country:US
Mailing Address - Phone:781-598-2100
Mailing Address - Fax:781-599-0514
Practice Address - Street 1:295 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3024
Practice Address - Country:US
Practice Address - Phone:781-598-2100
Practice Address - Fax:781-599-0514
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist