MEDICARE: DR. ALISSA EDWARDS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6542-15	WI

General Provider Information

NPI Number	:	1578874426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISSA EDWARDS D.D.S.

Provider Business Mailing Address
First Line	:	N2714 BUCKHORN DR
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-9611
Country	:	US
Telephone Number	:	414-975-2240
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E FRANKLIN ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-5434
Country	:	US
Telephone Number	:	920-733-2371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/18/2025

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