Provider Demographics
NPI:1194108456
Name:NEELY, ALISON FOSTER (DMD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:FOSTER
Last Name:NEELY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4994
Mailing Address - Country:US
Mailing Address - Phone:615-784-4330
Mailing Address - Fax:
Practice Address - Street 1:1715 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4994
Practice Address - Country:US
Practice Address - Phone:615-784-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10310122300000X
NC101191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice