Healthcare Provider Details

I. General information

NPI: 1447588199
Provider Name (Legal Business Name): ALLEN RASMUSSEN DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY ROAD BUILDING 237, FISHER DENTAL CLINIC
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

34317 N HAVERTON DR
GURNEE IL
60031-4283
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-5578
  • Fax:
Mailing address:
  • Phone: 702-302-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6000063
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: