=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619102548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN B. ALLISON, D.D.S., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2009
-----------------------------------------------------
Last Update Date | 11/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W HIGH ST
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37190-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-563-2112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 W HIGH ST
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37190-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-563-2112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | EMILY HARGROVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-563-2112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7536
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------