MEDICARE: DR. TERRENCE L ALLEMANG DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30016164	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	460507033027	OTHER	OH	CARESOURCE ID #
2	000000264404	OTHER	OH	ABCBS - PROVIDER #
3	884352	OTHER	OH	UNITED CONCORDIA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497725766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRENCE L ALLEMANG DDS

Provider Business Mailing Address
First Line	:	1487 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-667-0776
Fax Number	:	937-667-0854

Provider Business Practice Location Address
First Line	:	1487 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-667-0776
Fax Number	:	937-667-0854

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/09/2007

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