MEDICARE: DR. ALLEN K DORSEY 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	1223G0001X	General Practice Dentistry	53555	CA
2	1223G0001X	General Practice Dentistry	17923	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629181599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN K DORSEY DDS

Provider Business Mailing Address
First Line	:	10928 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1912
Country	:	US
Telephone Number	:	713-450-0000
Fax Number	:	713-450-2704

Provider Business Practice Location Address
First Line	:	10928 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1912
Country	:	US
Telephone Number	:	713-450-0000
Fax Number	:	713-450-2704

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/26/2021

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