Louise Allen

Individual provider Active NPI General Practice Dentistry · Cordova,, TN

NPI 1437243995 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1437243995
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
DS003782 (TN)
Practice address
278 German Oak Dr.
Cordova,, TN 38018-7220
Phone
(901) 753-9696
Fax
(901) 753-0760
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20160707000489 TN Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery
8426340738

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
DS003782TNMDGeneral Practice Dentistry
3782TNMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS003782 TN Yes

Addresses

Primary practice location

278 German Oak Dr.
Cordova,, TN 38018-7220

Mailing address

521 Stonewall St
Memphis, TN 38112
Phone (901) 272-3582

Other names

  • Miss Louise Rutkowski Former name

Other providers in Cordova,, TN

All providers in Cordova,, TN · General Practice Dentistry in Tennessee

Sources for this page

Verify at the official NPI Registry.