Provider Demographics
NPI:1114916038
Name:PIERCE, ALLEN DEANE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DEANE
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2152
Mailing Address - Country:US
Mailing Address - Phone:502-366-6362
Mailing Address - Fax:502-368-8600
Practice Address - Street 1:4825 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2152
Practice Address - Country:US
Practice Address - Phone:502-366-6362
Practice Address - Fax:502-368-8600
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60041829Medicaid
KY0353504Medicare ID - Type Unspecified