MEDICARE: DR. ALLISON PATRICIA MAULDEN DMD

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	1223G0001X	General Practice Dentistry	DN012981	GA
2	1223G0001X	General Practice Dentistry	5563	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679318	OTHER	AL	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821168675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON PATRICIA MAULDEN DMD

Provider Business Mailing Address
First Line	:	230 E 10TH ST STE 106
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36207-5771
Country	:	US
Telephone Number	:	256-741-7340
Fax Number	:	256-741-7373

Provider Business Practice Location Address
First Line	:	5412 MONTGOMERY HWY STE 8
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-1657
Country	:	US
Telephone Number	:	334-983-1730
Fax Number	:	334-983-1725

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/21/2022

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