MEDICARE: DR. ALLYSON NICOLE FEASEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	IN12011181A	IN

General Provider Information

NPI Number	:	1851556153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLYSON NICOLE FEASEL DDS

Provider Business Mailing Address
First Line	:	3030 LAKE AVE STE 15
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 LAKE AVE STE 15
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5428
Country	:	US
Telephone Number	:	317-607-7959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	04/14/2026

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