Healthcare Provider Details

I. General information

NPI: 1629295704
Provider Name (Legal Business Name): RYAN CLAYBOURNE ALLEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 E 29TH AVE
SPOKANE WA
99223-4815
US

IV. Provider business mailing address

3143 E 29TH AVE
SPOKANE WA
99223-4815
US

V. Phone/Fax

Practice location:
  • Phone: 509-536-5900
  • Fax: 509-534-1015
Mailing address:
  • Phone: 509-536-5900
  • Fax: 509-534-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010962
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7622
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: