Provider Demographics
NPI:1427100767
Name:ALLEN, R. CRAIG (DMD)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:CRAIG
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NOEL DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1386
Mailing Address - Country:US
Mailing Address - Phone:270-885-4156
Mailing Address - Fax:270-885-4031
Practice Address - Street 1:520 NOEL DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1386
Practice Address - Country:US
Practice Address - Phone:270-885-4156
Practice Address - Fax:270-885-4031
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900494Medicaid
KY60041985Medicaid