Individual
MR. MARK DERRICK ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
2861 RIDGE RD, ROCKWALL, TX 75032
(972) 772-2500
(972) 278-1320
Mailing address
2861 RIDGE RD, ROCKWALL, TX 75032
(972) 772-2500
(972) 278-1320
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
16321
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1927816
—
TX
Enumeration date
04/07/2011
Last updated
01/13/2022
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