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406 Longmire Rd Conroe TX 77304-2048 | |
| (936) 756-7611 | |
| (936) 756-7632 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 406 Longmire Rd, Conroe, Texas |
| Authorized Official Name and Position | Richard Earl Allen (PRESIDENT/DENTIST) |
| Authorized Official Contact | 9367567611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
406 Longmire Rd Conroe TX 77304-2048 Ph: (936) 756-7611 | 406 Longmire Rd Conroe TX 77304-2048 Ph: (936) 756-7611 |
| NPI Number | 1164798955 |
|---|---|
| Provider Enumeration Date | 03/27/2012 |
| Last Update Date | 03/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164798955 | NPI | - | NPPES |
| 090856801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 9019 (Texas) | Primary |
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