Healthcare Provider Details

I. General information

NPI: 1194107318
Provider Name (Legal Business Name): ALISON R KUDISH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON KUDISH D.M.D.

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LN STE 101
TRUMBULL CT
06611
US

IV. Provider business mailing address

160 HAWLEY LN STE 101
TRUMBULL CT
06611-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-0638
  • Fax:
Mailing address:
  • Phone: 203-377-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11698
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: