Provider Demographics
NPI:1649461906
Name:LEVANS, ALLISON (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:LEVANS
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 1:1565 13TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304
Mailing Address - Country:US
Mailing Address - Phone:620-257-5104
Mailing Address - Fax:620-257-5246
Practice Address - Street 1:4801 VETERANS DRIVE
Practice Address - Street 2:VETERANS HEALTH ADMINISTRATION
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-255-6373
Practice Address - Fax:620-257-5246
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60590122300000X
NMDD2926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist