Provider Demographics
NPI:1417641234
Name:ALLPHIN, AMMON JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMMON
Middle Name:JOSEPH
Last Name:ALLPHIN
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 1:2305 S BLACKMAN RD STE A100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2835
Mailing Address - Country:US
Mailing Address - Phone:417-887-3860
Mailing Address - Fax:
Practice Address - Street 1:2305 S BLACKMAN RD STE A100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-2835
Practice Address - Country:US
Practice Address - Phone:417-887-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230207201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice