MEDICARE: DR. HERMAN 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	122300000X	Dentist	DN4505	FL

General Provider Information

NPI Number	:	1821283847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERMAN ALLEN DDS

Provider Business Mailing Address
First Line	:	2323 NW 19TH STREET
Second Line	:	SUITE 1
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-3400
Country	:	US
Telephone Number	:	954-484-8780
Fax Number	:	954-484-8781

Provider Business Practice Location Address
First Line	:	2323 NW 19TH STREET
Second Line	:	SUITE 1
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-3400
Country	:	US
Telephone Number	:	954-484-8780
Fax Number	:	954-484-8781

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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