Provider Demographics
NPI:1851556153
Name:FEASEL, ALLYSON NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:NICOLE
Last Name:FEASEL
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 1:1020 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-1049
Mailing Address - Country:US
Mailing Address - Phone:260-724-8410
Mailing Address - Fax:206-724-0474
Practice Address - Street 1:1020 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1049
Practice Address - Country:US
Practice Address - Phone:260-724-8410
Practice Address - Fax:206-724-0474
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ12011181A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist