Roosevelt Allen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

4175 S Alamo Ave
Davis Monthan a F B, AZ 85707-6097

Phone

(520) 228-2654

NPI assigned

Jan 23, 2006

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1619947868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13857 E CANYON FAIRWAY TRL",
            "city": "VAIL",
            "state": "AZ",
            "postal_code": "856416464",
            "telephone_number": "757-876-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "DAVIS MONTHAN A F B",
            "state": "AZ",
            "postal_code": "857076097",
            "telephone_number": "520-228-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "ROOSEVELT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "LNO 4138",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 355TH Medgrp-Davis-Monthan (Dod Davis Monthan Pharmacy)
• Tyler Antonelli, DDS
• Chad Bechtle, O.D.
• Alexa Bergren, DDS
• Haley Anne Berkowitz, LICSW
• Jason Boehler, MSW

• General Practice Dentistry in Davis Monthan AFB, AZ
• Providers in Davis Monthan AFB, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.