Provider Demographics
NPI:1942330618
Name:ALLRED, MAURICE LOUIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:LOUIE
Last Name:ALLRED
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 1:9 MOHAWK CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2515
Mailing Address - Country:US
Mailing Address - Phone:501-804-4973
Mailing Address - Fax:
Practice Address - Street 1:9 MOHAWK CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2515
Practice Address - Country:US
Practice Address - Phone:501-804-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR18061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58242OtherPRACTICE BCBS ID
AR71-0775709OtherPRACTICE TAX ID
ARAR1806OtherSTATE DENTAL LICENSE