Healthcare Provider Details

I. General information

NPI: 1700031135
Provider Name (Legal Business Name): ALLEN DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 196TH ST SW 2-B,1-B
LYNNWOOD WA
98036-5959
US

IV. Provider business mailing address

6226 196TH ST SW 2-B,1-B
LYNNWOOD WA
98036-5959
US

V. Phone/Fax

Practice location:
  • Phone: 425-670-8670
  • Fax:
Mailing address:
  • Phone: 425-670-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00003007
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000017
License Number StateWA

VIII. Authorized Official

Name: ANDON D. ALLEN
Title or Position: OWNER
Credential: LD
Phone: 425-670-8670