Individual provider Active NPI

Alisa Fay Tolle, DMD

  • General Practice Dentistry
  • Winchester, KY
National Provider Identifier
1073675260
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6980 Issued in KY
Practice address
244 W Lexington Ave
Winchester, KY 40391-1957
Phone
(859) 745-4867
Fax
(859) 745-2350
NPI assigned
Dec 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6980 KY Primary

Addresses

Primary practice location

244 W Lexington Ave
Winchester, KY 40391-1957

Mailing address

244 W Lexington Ave
Winchester, KY 40391-1957
Phone (859) 745-4867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160606002000 KY Order and Referring Only - DentistPractitioner - Dentist 9234429150

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6980KYMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073675260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 W LEXINGTON AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403911957",
            "telephone_number": "859-745-4867",
            "fax_number": "859-745-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 W LEXINGTON AVE",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403911957",
            "telephone_number": "859-745-4867",
            "fax_number": "859-745-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLLE",
        "first_name": "ALISA",
        "middle_name": "FAY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, KY

Sources for this page

Verify at the official NPI Registry.