Provider Demographics
NPI:1205277191
Name:ALLISON, EDMOND J (DMD)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:J
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6845
Mailing Address - Country:US
Mailing Address - Phone:239-772-5005
Mailing Address - Fax:239-772-4929
Practice Address - Street 1:1527 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6845
Practice Address - Country:US
Practice Address - Phone:239-772-5005
Practice Address - Fax:239-772-4929
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00115501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528281755OtherNPI ORGANIZATION NUMBER