Healthcare Provider Details

I. General information

NPI: 1306861992
Provider Name (Legal Business Name): ALLEN D CARNES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6641 N HIGH ST SUITE 105
WORTHINGTON OH
43085-4038
US

IV. Provider business mailing address

6641 N HIGH ST SUITE 105
WORTHINGTON OH
43085-4038
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-3339
  • Fax: 614-885-1011
Mailing address:
  • Phone: 614-885-3339
  • Fax: 614-885-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: