Healthcare Provider Details

I. General information

NPI: 1124696612
Provider Name (Legal Business Name): COLTON ALEXANDER LYNN ALLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

IV. Provider business mailing address

4000 E CAMPUS LOOP S
LINCOLN NE
68583-1530
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1333
  • Fax:
Mailing address:
  • Phone: 307-640-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8014
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1617
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: