Provider Demographics
NPI:1962420836
Name:O'ROURKE-ALLEN, SANCERIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SANCERIE
Middle Name:
Last Name:O'ROURKE-ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8894 AIRLINE HWY
Mailing Address - Street 2:SUITE M
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4081
Mailing Address - Country:US
Mailing Address - Phone:225-218-9218
Mailing Address - Fax:225-218-9219
Practice Address - Street 1:8894 AIRLINE HWY
Practice Address - Street 2:SUITE M
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4081
Practice Address - Country:US
Practice Address - Phone:225-218-9218
Practice Address - Fax:225-218-9219
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1851311Medicaid