Provider Demographics
NPI:1962485193
Name:ALLISON, JANICE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MARIE
Last Name:ALLISON
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 1:411 MEADOWLARK STREET
Mailing Address - Street 2:SHAW AIR FORCE BASE, SHAW AFB
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29152-5019
Mailing Address - Country:US
Mailing Address - Phone:803-895-6064
Mailing Address - Fax:803-895-6539
Practice Address - Street 1:411 MEADOWLARK STREET
Practice Address - Street 2:SHAW AIR FORCE BASE, SHAW AFB
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29152-5019
Practice Address - Country:US
Practice Address - Phone:803-895-6064
Practice Address - Fax:803-895-6539
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice