Provider Demographics
NPI:1821296633
Name:MEAD, ALISON MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:MEAD
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 1:7766 W CIRCLE DR N
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-9634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 TRAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1534
Practice Address - Country:US
Practice Address - Phone:260-636-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010997A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist