Basic Information
Provider Information | |||||||||
NPI: | 1730473240 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MERA | ||||||||
FirstName: | ALISON | ||||||||
MiddleName: | KATHRYN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MOLNAR | ||||||||
OtherFirstName: | ALISON | ||||||||
OtherMiddleName: | KATHRYN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 17273 STATE ROUTE 104 | ||||||||
Address2: |   | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456019718 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407731141 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 17273 STATE ROUTE 104 | ||||||||
Address2: |   | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 456019718 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407731141 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2011 | ||||||||
LastUpdateDate: | 07/12/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 122300000X | 30.023582 | OH | Y |   | Dental Providers | Dentist |   |
No ID Information.