Healthcare Provider Details

I. General information

NPI: 1184727315
Provider Name (Legal Business Name): T SCOTT ALLEN DDS MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 PROFESSIONAL ACRES DR
JONESBORO AR
72401-4321
US

IV. Provider business mailing address

910 PROFESSIONAL ACRES DR
JONESBORO AR
72401-4321
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6516
  • Fax: 870-935-0188
Mailing address:
  • Phone: 870-935-6516
  • Fax: 870-935-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3047
License Number StateAR

VIII. Authorized Official

Name: DR. TERRY SCOTT ALLEN
Title or Position: OWNER PRESIDENT
Credential: DDS MS
Phone: 870-935-6516