=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730246000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRENCE L. ALLEMANG, DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1487 W MAIN ST
-----------------------------------------------------
City | TIPP CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45371-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-667-0776
-----------------------------------------------------
Fax | 937-667-0854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1487 W MAIN ST
-----------------------------------------------------
City | TIPP CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45371-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-667-0776
-----------------------------------------------------
Fax | 937-667-0854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TERRENCE L ALLEMANG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 937-667-0776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 30016164
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------