Healthcare Provider Details

I. General information

NPI: 1285881193
Provider Name (Legal Business Name): JOHN M. ALLEN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N ORANGE GROVE AVE
POMONA CA
91767-3006
US

IV. Provider business mailing address

1880 N ORANGE GROVE AVE
POMONA CA
91767-3006
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-3421
  • Fax: 909-629-9520
Mailing address:
  • Phone: 909-623-3421
  • Fax: 909-629-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number46235
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN M ALLEN
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 909-623-3421