Provider Demographics
NPI:1639747561
Name:KOTH, ALLIE JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLIE
Middle Name:JEAN
Last Name:KOTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-4407
Mailing Address - Country:US
Mailing Address - Phone:605-595-8880
Mailing Address - Fax:
Practice Address - Street 1:6908 S LYNCREST PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2565
Practice Address - Country:US
Practice Address - Phone:605-275-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77181223P0221X
SDD14011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry