Provider Demographics
NPI:1407909401
Name:ALLEN, TERRY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ROBERT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-651-8404
Mailing Address - Fax:808-748-0769
Practice Address - Street 1:4366 KUKUI GROVE ST STE 204
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-378-4754
Practice Address - Fax:808-748-0769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice