Provider Demographics
NPI:1437253580
Name:ALLEN, RICHARD M (GENERAL DENTIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 E BELL
Mailing Address - Street 2:#108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-493-0206
Mailing Address - Fax:602-493-2081
Practice Address - Street 1:1618 E BELL
Practice Address - Street 2:#108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-493-0206
Practice Address - Fax:602-493-2081
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice