Provider Demographics
NPI:1912675265
Name:GAFFNEY, ALISHA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:MARIE
Last Name:GAFFNEY
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 1:316 S GROVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8017
Mailing Address - Country:US
Mailing Address - Phone:541-821-4797
Mailing Address - Fax:
Practice Address - Street 1:1920 E RIVERSIDE DR STE A-140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1351
Practice Address - Country:US
Practice Address - Phone:512-640-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist