Healthcare Provider Details

I. General information

NPI: 1174567499
Provider Name (Legal Business Name): ALENE MARIE D'ALESIO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUCKHORN DR
MOON TWP PA
15108-9470
US

IV. Provider business mailing address

4001 DUCKHORN DR
MOON TWP PA
15108-9470
US

V. Phone/Fax

Practice location:
  • Phone: 412-427-2138
  • Fax:
Mailing address:
  • Phone: 412-427-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS036645
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001845956
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUCCI
# 2
Identifier1016036930001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: