Provider Demographics
NPI:1679345698
Name:ALLO, RYAN NGOTCHO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NGOTCHO
Last Name:ALLO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5055
Mailing Address - Country:US
Mailing Address - Phone:469-835-3204
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1264
Practice Address - Country:US
Practice Address - Phone:214-453-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401281223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist