Provider Demographics
NPI:1225003171
Name:ALLEN, ROGER D (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:ALLEN
Suffix:
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 1:405 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5101
Mailing Address - Country:US
Mailing Address - Phone:256-546-1341
Mailing Address - Fax:256-546-1343
Practice Address - Street 1:405 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5101
Practice Address - Country:US
Practice Address - Phone:256-546-1341
Practice Address - Fax:256-546-1343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47561223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL21930OtherBLUE CROSS PROVIDER
AL89371Medicare UPIN