Provider Demographics
NPI:1669603338
Name:BROYLES, ALLISON CAROL (DMD, MS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:CAROL
Last Name:BROYLES
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SW CAMPUS DR # 19
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3001
Mailing Address - Country:US
Mailing Address - Phone:503-494-4316
Mailing Address - Fax:503-494-8384
Practice Address - Street 1:611 SW CAMPUS DR # 19
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3001
Practice Address - Country:US
Practice Address - Phone:503-494-4316
Practice Address - Fax:503-494-8384
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics