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General NPI Number Information
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NPI Number | 1982492864
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Entity Type | Organization
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Legal Business Name | ALISSA EDWARDS DDS LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 229 E FRANKLIN ST
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City | APPLETON
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State | WI
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Zip | 54911-5434
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Country | US
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Telephone | 920-733-2371
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Fax |
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Provider Business Mailing Address
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Address Line | N2714 BUCKHORN DR
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City | APPLETON
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State | WI
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Zip | 54913-9611
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Country | US
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Telephone | 414-975-2240
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALISSA PONCZOCH
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Credential |
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Telephone | 414-975-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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