Provider Demographics
NPI:1750739082
Name:KOXLIEN, ALISHA KAY (DMD)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:KAY
Last Name:KOXLIEN
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:N20777 US HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:GALESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54630-8634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19815 E GALE AVE
Practice Address - Street 2:
Practice Address - City:GALESVILLE
Practice Address - State:WI
Practice Address - Zip Code:54630-7313
Practice Address - Country:US
Practice Address - Phone:608-582-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001302-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice