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General NPI Number Information
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NPI Number | 1033040092
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Entity Type | Individual
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Provider Name | ELI BERTRAM ALLEN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2026
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Last Update Date | 05/28/2026
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Provider Practice Location Address
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Address Line | 4041 PARNELL AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-1413
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Country | US
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Telephone | 260-297-7511
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Fax |
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Provider Business Mailing Address
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Address Line | 1143 W RUDISILL BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46807-2142
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Country | US
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Telephone | 260-417-2563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12014983A
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License Number State | IN
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