Healthcare Provider Details

I. General information

NPI: 1437376068
Provider Name (Legal Business Name): ANDON DAN ALLEN LD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5527 6TH AVE NW
TULALIP WA
98271-6531
US

V. Phone/Fax

Practice location:
  • Phone: 425-670-8670
  • Fax: 425-670-0491
Mailing address:
  • Phone: 360-657-3315
  • Fax: 425-670-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number00000017
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: