MEDICARE: RICHARD DWIGHT ALLEN D.D.S.

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	:	1215155734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DWIGHT ALLEN D.D.S.

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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