MEDICARE: DR. STEPHANIE JENKINS ALLEN DMD

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	122300000X	Dentist	8862	KY
2	122300000X	Dentist	12011440A	IN

General Provider Information

NPI Number	:	1407175177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE JENKINS ALLEN DMD

Provider Business Mailing Address
First Line	:	434 PATROL RD STE 200
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7754
Country	:	US
Telephone Number	:	812-850-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 PATROL RD STE 200
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7754
Country	:	US
Telephone Number	:	812-850-2129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	11/12/2020

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