Provider Demographics
NPI:1215155734
Name:ALLEN, RICHARD DWIGHT (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DWIGHT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 S CLEVELAND AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3902
Mailing Address - Country:US
Mailing Address - Phone:605-221-0218
Mailing Address - Fax:
Practice Address - Street 1:1704 S CLEVELAND AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3902
Practice Address - Country:US
Practice Address - Phone:605-221-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics