Provider Demographics
NPI:1982184800
Name:WISNIEWSKI, ALLISON PAIGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:PAIGE
Last Name:WISNIEWSKI
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 1:6419 REFLECTION DR APT 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3128
Mailing Address - Country:US
Mailing Address - Phone:262-865-0272
Mailing Address - Fax:
Practice Address - Street 1:2948 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2934
Practice Address - Country:US
Practice Address - Phone:619-684-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice