Healthcare Provider Details

I. General information

NPI: 1174997100
Provider Name (Legal Business Name): ALLEN SARATOGA DENTISTRY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SARATOGA BLVD UNIT 2
CORPUS CHRISTI TX
78414-3478
US

IV. Provider business mailing address

6200 SARATOGA BLVD UNIT 2
CORPUS CHRISTI TX
78414-3478
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21712
License Number StateTX

VIII. Authorized Official

Name: CHARLES ALLEN JR.
Title or Position: MEMBER
Credential:
Phone: 361-854-7999