Healthcare Provider Details

I. General information

NPI: 1558355982
Provider Name (Legal Business Name): ALLISON ROSE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 ISLAND AVE
PHILADELPHIA PA
19153-2300
US

IV. Provider business mailing address

1637 OAKWOOD DR SOUTH 319
NARBERTH PA
19072-1002
US

V. Phone/Fax

Practice location:
  • Phone: 215-365-1033
  • Fax: 215-365-1145
Mailing address:
  • Phone: 610-617-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS-031312L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: