MEDICARE: HALEY ANN ALLEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	RES.004357	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	30.026953	OH

General Provider Information

NPI Number	:	1114592631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY ANN ALLEN DDS

Provider Business Mailing Address
First Line	:	4163 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3332
Country	:	US
Telephone Number	:	216-860-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4163 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3332
Country	:	US
Telephone Number	:	216-860-0120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	07/25/2022

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