MEDICARE: RONALD K. ALLEN DDS MSD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285356246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD K. ALLEN DDS MSD PC

Provider Business Mailing Address
First Line	:	9524 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9524 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3031
Country	:	US
Telephone Number	:	317-898-2311
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELEAH ABLITAR
Credential	:
Telephone Number	:	317-260-1145

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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