Provider Demographics
NPI:1659950236
Name:LEECOCK, ALISON STEPHANIE (DMD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:STEPHANIE
Last Name:LEECOCK
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 1:2 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-2259
Mailing Address - Country:US
Mailing Address - Phone:413-636-8612
Mailing Address - Fax:
Practice Address - Street 1:79 BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2999
Practice Address - Country:US
Practice Address - Phone:413-562-5494
Practice Address - Fax:413-568-5597
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA18593891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program