Healthcare Provider Details

I. General information

NPI: 1821507401
Provider Name (Legal Business Name): ALISON L. BOONE, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MILL END CT STE A
ELIZABETH CITY NC
27909-8987
US

IV. Provider business mailing address

101 MILL END CT STE A
ELIZABETH CITY NC
27909-8987
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-2050
  • Fax: 252-335-2052
Mailing address:
  • Phone: 252-331-2050
  • Fax: 252-335-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BETSY HENDRICKS
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-331-2050