Healthcare Provider Details

I. General information

NPI: 1093409922
Provider Name (Legal Business Name): ALLEN VAKHLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 DESERT STORM AVE
FORT CAMPBELL KY
42223-5586
US

IV. Provider business mailing address

21 CARTER RD
EAST BRUNSWICK NJ
08816-4603
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-6362
  • Fax:
Mailing address:
  • Phone: 646-577-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044127
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: