Provider Demographics
NPI:1497725766
Name:ALLEMANG, TERRENCE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:L
Last Name:ALLEMANG
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 1:1487 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-2803
Mailing Address - Country:US
Mailing Address - Phone:937-667-0776
Mailing Address - Fax:937-667-0854
Practice Address - Street 1:1487 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2803
Practice Address - Country:US
Practice Address - Phone:937-667-0776
Practice Address - Fax:937-667-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300161641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH460507033027OtherCARESOURCE ID #
OH000000264404OtherABCBS - PROVIDER #
OH884352OtherUNITED CONCORDIA
OH0960607Medicaid
OHU56149Medicare UPIN
OHAL0753963Medicare ID - Type UnspecifiedPROVIDER #