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DR. ROOSEVELT ALLEN DDS
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1619947868
Individual Registrant:DR. ROOSEVELT ALLEN DDS
Gender: M
Gender: M
Location and contact information for practice:
4175 S ALAMO AVE DAVIS MONTHAN A F B, AZ 85707-6097 US
Tel: 520-228-2654 Fax: --
Tel: 520-228-2654 Fax: --
Contact information for business:
13857 E CANYON FAIRWAY TRL VAIL, AZ 85641-6464 US
Tel: 757-876-3082 Fax: --
Tel: 757-876-3082 Fax: --
Registration Information:
NPI: 1619947868
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| X | 122300000X | Dental Providers Dentist | AL | LNO 4138 |
| X | 1223G0001X | Dental Providers Dentist | DE |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
