Provider Demographics
NPI:1245331024
Name:ALLEN, GREGORY A
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
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 1:15140 PAWNEE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224
Mailing Address - Country:US
Mailing Address - Phone:913-851-2527
Mailing Address - Fax:
Practice Address - Street 1:1010 CARONDELET DR.
Practice Address - Street 2:SUITE 316
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-941-0000
Practice Address - Fax:816-941-3146
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130231223S0112X
KS70461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T73802Medicare UPIN
MOB056020AMedicare ID - Type Unspecified