Provider Demographics
NPI:1528341674
Name:KISNER, ALLISON MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MARIE
Last Name:KISNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2804
Mailing Address - Country:US
Mailing Address - Phone:309-853-3393
Mailing Address - Fax:309-852-4060
Practice Address - Street 1:6606 CHARLOTTE PIKE STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4256
Practice Address - Country:US
Practice Address - Phone:615-864-8941
Practice Address - Fax:615-864-8946
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08859122300000X
IL019028862122300000X
TN109841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist