Healthcare Provider Details

I. General information

NPI: 1689751067
Provider Name (Legal Business Name): CASEY CRAIG ALLMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 NIGHT WHISPER RD NW SUITE 100
ALBUQUERQUE NM
87114-1575
US

IV. Provider business mailing address

5740 NIGHT WHISPER RD NW SUITE 100
ALBUQUERQUE NM
87114-1575
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-1585
  • Fax: 505-792-1587
Mailing address:
  • Phone: 505-792-1585
  • Fax: 505-792-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2838
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5051
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: