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General NPI Number Information
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NPI Number | 1285166017
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Entity Type | Individual
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Provider Name | ALLISON LAWRENCE ELLIS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 6858 OLD DOMINION DR SUITE 100
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City | MC LEAN
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State | VA
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Zip | 22101-3899
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Country | US
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Telephone | 703-356-8781
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Fax |
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Provider Business Mailing Address
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Address Line | 32 TERRACE AVE
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City | RIVERSIDE
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State | CT
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Zip | 06878-2124
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Country | US
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Telephone | 703-969-4425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13003
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 050449-01
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License Number State | NY
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