Provider Demographics
NPI:1912286360
Name:ALLEN, RYAN BLAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BLAINE
Last Name:ALLEN
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 1:2251 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7210
Mailing Address - Country:US
Mailing Address - Phone:801-782-9544
Mailing Address - Fax:
Practice Address - Street 1:2251 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7210
Practice Address - Country:US
Practice Address - Phone:801-782-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8029238-99221223G0001X
UT8029238-8903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist