Basic Information
| Provider Information | |||||||||
| NPI: | 1740844224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTONI | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | TRACY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1934 S VIEW ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841053712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099817649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3740 SOUTH 14TH STREET | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS-MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539675271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.