Provider Demographics
NPI:1447588199
Name:RASMUSSEN, ALLEN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34317 N HAVERTON DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4283
Mailing Address - Country:US
Mailing Address - Phone:702-302-6024
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY ROAD
Practice Address - Street 2:BUILDING 237, FISHER DENTAL CLINIC
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:760-725-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589951223G0001X
WI60000631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice