Provider Demographics
NPI:1194107318
Name:KUDISH, ALISON R (DMD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:R
Last Name:KUDISH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:KUDISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:160 HAWLEY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5300
Mailing Address - Country:US
Mailing Address - Phone:203-377-0638
Mailing Address - Fax:
Practice Address - Street 1:160 HAWLEY LN STE 101
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-377-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist