Provider Demographics
NPI:1760975395
Name:ROLLI, ALYSHA (DMD)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:ROLLI
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 1:2702 MONROE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1896
Mailing Address - Country:US
Mailing Address - Phone:608-204-0222
Mailing Address - Fax:
Practice Address - Street 1:2702 MONROE ST STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1896
Practice Address - Country:US
Practice Address - Phone:608-204-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001813-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist