Provider Demographics
NPI:1790042935
Name:WIDMANN, ALLISON RUFO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:RUFO
Last Name:WIDMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2650 HOLCOMB BRIDGE ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1826
Mailing Address - Country:US
Mailing Address - Phone:678-352-1333
Mailing Address - Fax:678-352-1335
Practice Address - Street 1:2650 HOLCOMB BRIDGE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1826
Practice Address - Country:US
Practice Address - Phone:678-352-1333
Practice Address - Fax:678-352-1335
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0104201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice