Healthcare Provider Details

I. General information

NPI: 1326178427
Provider Name (Legal Business Name): DAVID C ALLEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 SO 48TH ST
QUINCY IL
62305-9102
US

IV. Provider business mailing address

435 HICKORY POINTE APT # 3
QUINCY IL
62305
US

V. Phone/Fax

Practice location:
  • Phone: 217-228-9467
  • Fax: 217-228-0131
Mailing address:
  • Phone: 217-641-3018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: