Healthcare Provider Details

I. General information

NPI: 1396796793
Provider Name (Legal Business Name): JOHN MICHAEL ALLEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE ST LUKES DIVISION OF ORAL & MAXILLOFACIAL SURGERY
NEW YORK NY
10025
US

IV. Provider business mailing address

200 W 60TH ST #16A
NEW YORK NY
10023-8506
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-3171
  • Fax: 212-523-2447
Mailing address:
  • Phone: 917-608-0868
  • Fax: 212-523-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number052730
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number46235
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDNF000323
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number052730
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number46235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: