Terry Scott Allen

Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Jonesboro, AR

NPI 1679748958 · NPPES record last updated Apr 28, 2008

Key facts

NPI
1679748958
Entity type
Individual (NPI type 1)
Primary specialty
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
License
3047 (AR)
Practice address
911 Osler Dr Ste D
Jonesboro, AR 72401-4320
Phone
(870) 935-6516
Fax
(870) 935-0818
NPI assigned
Apr 28, 2008
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
3047ARMDOrthodontics and Dentofacial Orthopedic Dentist
3147ARMDOrthodontics and Dentofacial Orthopedic Dentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 3147 AR
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 3047 AR Yes

Addresses

Primary practice location

911 Osler Dr Ste D
Jonesboro, AR 72401-4320

Mailing address

911 Osler Dr Ste D
Jonesboro, AR 72401-4320
Phone (870) 935-6516

Other providers in Jonesboro, AR

All providers in Jonesboro, AR · Orthodontics and Dentofacial Orthopedics Dentistry in Arkansas

Sources for this page

Verify at the official NPI Registry.