Healthcare Provider Details

I. General information

NPI: 1255421715
Provider Name (Legal Business Name): RONALD K. ALLEN D.D.S.,M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9524 E. WASHINGTON STREET
INDIANAPOLIS IN
46229-3031
US

IV. Provider business mailing address

9524 E. WASHINGTON STREET
INDIANAPOLIS IN
46229-3031
US

V. Phone/Fax

Practice location:
  • Phone: 317-898-2311
  • Fax: 317-869-0106
Mailing address:
  • Phone: 317-898-2311
  • Fax: 317-869-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12008248
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: