Healthcare Provider Details

I. General information

NPI: 1013076397
Provider Name (Legal Business Name): JAMES DOUGLAS ALLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S WHITEHEAD DR
DEWITT AR
72042
US

IV. Provider business mailing address

PO DRAWER 512 1703 S WHITEHEAD DR
DEWITT AR
72042
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-2013
  • Fax: 870-946-1281
Mailing address:
  • Phone: 870-946-2013
  • Fax: 870-946-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3490
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: