Provider Demographics
NPI:1477294858
Name:MARONEY, ALISSA C (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:C
Last Name:MARONEY
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10757 STONEBRIDGE TRL N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9569
Mailing Address - Country:US
Mailing Address - Phone:651-491-2890
Mailing Address - Fax:
Practice Address - Street 1:12425 55TH ST N STE B
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-4450
Practice Address - Country:US
Practice Address - Phone:651-439-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7927124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist