Provider Demographics
NPI:1255421715
Name:ALLEN, RONALD K (DDS,MSD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9524 E. WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3031
Mailing Address - Country:US
Mailing Address - Phone:317-898-2311
Mailing Address - Fax:317-869-0106
Practice Address - Street 1:9524 E. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3031
Practice Address - Country:US
Practice Address - Phone:317-898-2311
Practice Address - Fax:317-869-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120082481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200454310AMedicaid