Healthcare Provider Details

I. General information

NPI: 1013400746
Provider Name (Legal Business Name): JEFFREY ALLEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 US HIGHWAY 1
ROCKLEDGE FL
32955-2128
US

IV. Provider business mailing address

980 US HIGHWAY 1
ROCKLEDGE FL
32955-2128
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-5323
  • Fax: 321-632-5323
Mailing address:
  • Phone: 321-632-5323
  • Fax: 321-632-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: