MEDICARE: DR. KATHRYN SUMNER ALLEN D.D.S.

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	DS0000009302	TN

General Provider Information

NPI Number	:	1740537943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN SUMNER ALLEN D.D.S.

Provider Business Mailing Address
First Line	:	1404 BELMEADE PL
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1599 FORT HENRY DR STE 102
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2535
Country	:	US
Telephone Number	:	423-247-8172
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	02/07/2022

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