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DR. ROOSEVELT ALLEN DDS

>> Dentist >> Dental Providers

Registrant NPI Number: 1619947868

Individual Registrant:
DR. ROOSEVELT  ALLEN DDS
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: --

Contact information for business:
13857 E CANYON FAIRWAY TRL  VAIL, AZ 85641-6464 US
Tel: 757-876-3082  Fax: --

Registration Information:
NPI: 1619947868
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X122300000XDental Providers
Dentist
ALLNO 4138
X1223G0001XDental Providers
Dentist
DE

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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