Healthcare Provider Details

I. General information

NPI: 1134407406
Provider Name (Legal Business Name): ALISON JACKSON HEUSNER D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 STATE ROAD 70 EAST
BRADENTON FL
34202
US

IV. Provider business mailing address

5002 PRESTON WAY
SARASOTA FL
34232-2301
US

V. Phone/Fax

Practice location:
  • Phone: 941-757-0490
  • Fax:
Mailing address:
  • Phone: 941-376-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: