MEDICARE: RICHARD D. ALLEN, D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	M850	SD

General Provider Information

NPI Number	:	1205962594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD D. ALLEN, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	1704 S CLEVELAND AVE
Second Line	:	SUITE 6
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-3902
Country	:	US
Telephone Number	:	605-221-0218
Fax Number	:	605-221-0220

Provider Business Practice Location Address
First Line	:	1704 S CLEVELAND AVE
Second Line	:	SUITE 6
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-3902
Country	:	US
Telephone Number	:	605-221-0218
Fax Number	:	605-221-0220

Authorized Official
Title or Position	:	OFFICE MANAGER OR D.D.S. PRESIDENT
Name	:	TAMMRA OR RICHARD RAE OR DWIGHT ALLEN
Credential	:
Telephone Number	:	605-221-0218

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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