Provider Demographics
NPI:1053393504
Name:ERROL J. ALLISON, D.D.S., P.C.
Entity type:Organization
Organization Name:ERROL J. ALLISON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-456-3311
Mailing Address - Street 1:1 PLAZA SOUTH ST
Mailing Address - Street 2:SUITE 149
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4750
Mailing Address - Country:US
Mailing Address - Phone:918-456-3311
Mailing Address - Fax:918-456-1254
Practice Address - Street 1:3070 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5402
Practice Address - Country:US
Practice Address - Phone:918-456-3311
Practice Address - Fax:918-456-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX IDENTIFICATION NUMBER