Individual provider Active NPI

Alison Geniec Revling, DDS

  • Dentist
  • Bend, OR
National Provider Identifier
1861052730
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11068 Issued in OR
Practice address
2381 NE Conners Ave
Bend, OR 97701-6068
Phone
(541) 786-2626
Fax
(541) 516-4039
NPI assigned
Jun 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D11068 OR Primary

Addresses

Primary practice location

2381 NE Conners Ave
Bend, OR 97701-6068

Mailing address

2381 NE Conners Ave
Bend, OR 97701-6068
Phone (541) 678-6262

Other names 1

  • Alison Elizabeth Geniec Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20250609002615 OR Order and Referring Only - DentistPractitioner - Dentist 2062922032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D11068ORMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1861052730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2381 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016068",
            "telephone_number": "541-678-6262",
            "fax_number": "541-516-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2381 NE CONNERS AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016068",
            "telephone_number": "541-786-2626",
            "fax_number": "541-516-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVLING",
        "first_name": "ALISON",
        "middle_name": "GENIEC",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISON",
            "last_name": "GENIEC",
            "middle_name": "ELIZABETH",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.