Provider Demographics
NPI:1437243995
Name:ALLEN, LOUISE
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:RUTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:521 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112
Mailing Address - Country:US
Mailing Address - Phone:901-272-3582
Mailing Address - Fax:
Practice Address - Street 1:278 GERMAN OAK DR.
Practice Address - Street 2:
Practice Address - City:CORDOVA,
Practice Address - State:TN
Practice Address - Zip Code:38018-7220
Practice Address - Country:US
Practice Address - Phone:901-753-9696
Practice Address - Fax:901-753-0760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0037821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice