Provider Demographics
NPI:1184727315
Name:T SCOTT ALLEN DDS MS
Entity type:Organization
Organization Name:T SCOTT ALLEN DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:870-935-6516
Mailing Address - Street 1:910 PROFESSIONAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4321
Mailing Address - Country:US
Mailing Address - Phone:870-935-6516
Mailing Address - Fax:870-935-0188
Practice Address - Street 1:910 PROFESSIONAL ACRES DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4321
Practice Address - Country:US
Practice Address - Phone:870-935-6516
Practice Address - Fax:870-935-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty