Provider Demographics
NPI:1861052730
Name:REVLING, ALISON GENIEC (DDS)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:GENIEC
Last Name:REVLING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:ELIZABETH
Other - Last Name:GENIEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2381 NE CONNERS AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6068
Mailing Address - Country:US
Mailing Address - Phone:541-678-6262
Mailing Address - Fax:541-516-4039
Practice Address - Street 1:2381 NE CONNERS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6068
Practice Address - Country:US
Practice Address - Phone:541-786-2626
Practice Address - Fax:541-516-4039
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist