Healthcare Provider Details

I. General information

NPI: 1962439950
Provider Name (Legal Business Name): MICHELE E ALLEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CHARLES STREET
BANGOR MI
49013
US

IV. Provider business mailing address

50 INDUSTRIAL PARK DRIVE
BANGOR MI
49013
US

V. Phone/Fax

Practice location:
  • Phone: 269-427-7969
  • Fax: 269-427-9539
Mailing address:
  • Phone: 269-427-7937
  • Fax: 269-427-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: