Provider Demographics
NPI:1205191939
Name:ALLISON, STEFANI JOY (DMD)
Entity type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:JOY
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVENUE K SE STE 1
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4003
Mailing Address - Country:US
Mailing Address - Phone:863-299-2192
Mailing Address - Fax:863-293-4219
Practice Address - Street 1:200 AVENUE K SE STE 1
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4003
Practice Address - Country:US
Practice Address - Phone:863-299-2192
Practice Address - Fax:863-293-4219
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 197681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice