Provider Demographics
NPI:1679748958
Name:ALLEN, TERRY SCOTT
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:SCOTT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 OSLER DR STE D
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4320
Mailing Address - Country:US
Mailing Address - Phone:870-935-6516
Mailing Address - Fax:870-935-0818
Practice Address - Street 1:911 OSLER DR STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4320
Practice Address - Country:US
Practice Address - Phone:870-935-6516
Practice Address - Fax:870-935-0818
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31471223X0400X
AR30471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics