Provider Demographics
NPI:1457796625
Name:GHAN, ALLISON (DMD, MSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GHAN
Suffix:
Gender:
Credentials:DMD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 W FILLMORE ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-3812
Mailing Address - Country:US
Mailing Address - Phone:602-258-6008
Mailing Address - Fax:
Practice Address - Street 1:1929 W FILLMORE ST BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3812
Practice Address - Country:US
Practice Address - Phone:602-258-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AZD0121161223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator