Healthcare Provider Details

I. General information

NPI: 1992281893
Provider Name (Legal Business Name): GARY W. ALLEN, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE STE B200
VANCOUVER WA
98686-6412
US

IV. Provider business mailing address

14201 NE 20TH AVE STE B200
VANCOUVER WA
98686-6412
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-0222
  • Fax:
Mailing address:
  • Phone: 888-480-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOIE
Title or Position: CEO
Credential:
Phone: 888-480-4478