MEDICARE: ALISON L. BOONE, DDS

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
2	122300000X	Dentist

General Provider Information

NPI Number	:	1821507401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALISON L. BOONE, DDS

Provider Business Mailing Address
First Line	:	101 MILL END CT STE A
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-8987
Country	:	US
Telephone Number	:	252-331-2050
Fax Number	:	252-335-2052

Provider Business Practice Location Address
First Line	:	101 MILL END CT STE A
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-8987
Country	:	US
Telephone Number	:	252-331-2050
Fax Number	:	252-335-2052

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BETSY HENDRICKS
Credential	:
Telephone Number	:	252-331-2050

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	03/16/2021

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