MEDICARE: KENNETH B. ALLEN, DDS, PC

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	8155	CO

General Provider Information

NPI Number	:	1336352848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH B. ALLEN, DDS, PC

Provider Business Mailing Address
First Line	:	1337 RIVERSIDE AVE
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4373
Country	:	US
Telephone Number	:	970-221-1658
Fax Number	:	970-482-7549

Provider Business Practice Location Address
First Line	:	1337 RIVERSIDE AVE
Second Line	:	SUITE 1
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4373
Country	:	US
Telephone Number	:	970-221-1658
Fax Number	:	970-482-7549

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH B ALLEN
Credential	:	D.D.S.
Telephone Number	:	970-221-1658

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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