Healthcare Provider Details

I. General information

NPI: 1508693383
Provider Name (Legal Business Name): ANDREA MARLE ALLEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE STE 130
OCOEE FL
34761-4519
US

IV. Provider business mailing address

2223 GARDEN BELLE DR
CLERMONT FL
34711-9561
US

V. Phone/Fax

Practice location:
  • Phone: 407-523-5400
  • Fax:
Mailing address:
  • Phone: 727-599-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: