Provider Demographics
NPI:1740023670
Name:TOLLIVER, ALISON BROOKE KING (DDS)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:BROOKE KING
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 LAMBERT DR APT 10
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1189
Mailing Address - Country:US
Mailing Address - Phone:304-593-9377
Mailing Address - Fax:
Practice Address - Street 1:176 VALLEY ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7306
Practice Address - Country:US
Practice Address - Phone:304-586-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice