Provider Demographics
NPI:1063798882
Name:DOOLEY, ALLISON (RDH, DT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:RDH, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 HAMLET AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3886
Mailing Address - Country:US
Mailing Address - Phone:651-485-9281
Mailing Address - Fax:
Practice Address - Street 1:9631 HAMLET AVE S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3886
Practice Address - Country:US
Practice Address - Phone:651-485-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH5057124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist