Provider Demographics
NPI:1164798955
Name:RICHARD E. ALLEN, D.D.S., INC.
Entity Type:Organization
Organization Name:RICHARD E. ALLEN, D.D.S., INC.
Other - Org Name:DR. RICHARD E. ALLEN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-756-7611
Mailing Address - Street 1:406 LONGMIRE RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2048
Mailing Address - Country:US
Mailing Address - Phone:936-756-7611
Mailing Address - Fax:936-756-7632
Practice Address - Street 1:406 LONGMIRE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2048
Practice Address - Country:US
Practice Address - Phone:936-756-7611
Practice Address - Fax:936-756-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090856801Medicaid