Provider Demographics
NPI:1407175177
Name:ALLEN, STEPHANIE JENKINS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JENKINS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 PATROL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7754
Mailing Address - Country:US
Mailing Address - Phone:812-850-2129
Mailing Address - Fax:
Practice Address - Street 1:434 PATROL RD STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7754
Practice Address - Country:US
Practice Address - Phone:812-850-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8862122300000X
IN12011440A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty