Healthcare Provider Details

I. General information

NPI: 1992753933
Provider Name (Legal Business Name): J MICHAEL ALLEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N ST
AURORA NE
68818-0289
US

IV. Provider business mailing address

PO BOX 289
AURORA NE
68818-0289
US

V. Phone/Fax

Practice location:
  • Phone: 402-694-2044
  • Fax: 402-694-6244
Mailing address:
  • Phone: 402-694-2044
  • Fax: 402-694-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number4441
License Number StateNE

VIII. Authorized Official

Name: J MICHAEL ALLEN
Title or Position: PRES
Credential: DDS
Phone: 402-684-2044