Provider Demographics
NPI:1033748348
Name:ALISON, JACLYN BATES (DMD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:BATES
Last Name:ALISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ELIZABETH
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2228 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2435
Mailing Address - Country:US
Mailing Address - Phone:205-587-4774
Mailing Address - Fax:
Practice Address - Street 1:1973 CHANDALAR DR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-4359
Practice Address - Country:US
Practice Address - Phone:206-524-1600
Practice Address - Fax:206-524-1603
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0006940-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist