Healthcare Provider Details

I. General information

NPI: 1720282700
Provider Name (Legal Business Name): MICHAEL D. ALLEN, DDS, MS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 NW 63RD ST
OKLAHOMA CITY OK
73116-2041
US

IV. Provider business mailing address

3621 NW 63RD ST
OKLAHOMA CITY OK
73116-2041
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-2834
  • Fax: 405-848-9332
Mailing address:
  • Phone: 405-840-2834
  • Fax: 405-848-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3829
License Number StateOK

VIII. Authorized Official

Name: DR. MICHAEL DENNIS ALLEN
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 405-840-2834