Provider Demographics
NPI:1316002736
Name:ALLEN, TINA LOUISE (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9511
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-0311
Mailing Address - Country:US
Mailing Address - Phone:816-358-4728
Mailing Address - Fax:
Practice Address - Street 1:10016 E 67TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5219
Practice Address - Country:US
Practice Address - Phone:816-737-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003096124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist