Provider Demographics
NPI:1457330441
Name:ALLOWITZ, RYAN JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAY
Last Name:ALLOWITZ
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 1:2703 TRADE PLACE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:254-778-4400
Mailing Address - Fax:254-778-4488
Practice Address - Street 1:2703 TRADE PLACE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-778-4400
Practice Address - Fax:254-778-4488
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087511223G0001X
TX243851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA8534477OtherFEDERAL DEA
BA8686240OtherFEDERAL DEA