Provider Demographics
NPI:1902116197
Name:BEEHNER, ALLISON KAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:KAY
Last Name:BEEHNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 FORT JESSE RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2103
Mailing Address - Country:US
Mailing Address - Phone:309-452-2404
Mailing Address - Fax:309-452-2469
Practice Address - Street 1:1523 FORT JESSE RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2103
Practice Address - Country:US
Practice Address - Phone:309-452-2404
Practice Address - Fax:309-452-2469
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist