Provider Demographics
NPI:1629443544
Name:SCULLY, ALLISON C (DDS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:SCULLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 W MICHIGAN STREET DS307B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5186
Mailing Address - Country:US
Mailing Address - Phone:317-274-7433
Mailing Address - Fax:317-274-2603
Practice Address - Street 1:1121 W MICHIGAN STREET DS307B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5186
Practice Address - Country:US
Practice Address - Phone:317-274-7433
Practice Address - Fax:317-274-2603
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012873A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry