Healthcare Provider Details

I. General information

NPI: 1245481472
Provider Name (Legal Business Name): WILLIAM ROBERT ALLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13901 COASTAL HIGHWAY
OCEAN CITY MD
21842
US

IV. Provider business mailing address

13901 COASTAL HIGHWAY
OCEAN CITY MD
21842
US

V. Phone/Fax

Practice location:
  • Phone: 410-250-1559
  • Fax: 410-250-1559
Mailing address:
  • Phone: 410-250-1559
  • Fax: 410-250-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12681
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12681
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: