Healthcare Provider Details

I. General information

NPI: 1578770046
Provider Name (Legal Business Name): ALLEN DENTAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W. BOYD DRIVE
ALLEN TX
75013-2518
US

IV. Provider business mailing address

300 W. BOYD DRIVE
ALLEN TX
75013-2518
US

V. Phone/Fax

Practice location:
  • Phone: 972-727-3941
  • Fax: 972-727-4352
Mailing address:
  • Phone: 972-727-3941
  • Fax: 972-727-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18761
License Number StateTX

VIII. Authorized Official

Name: DR. JEFFREY WILLIAMS
Title or Position: BUSINESS OWNER
Credential: D.D.S.
Phone: 972-727-3941