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General NPI Number Information
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NPI Number | 1033461660
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Entity Type | Organization
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Legal Business Name | JAMES CANNON ALLEN DDS PC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 106 E 1ST NORTH
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-5600
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Fax | 208-419-0202
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Provider Business Mailing Address
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Address Line | 106 E 1ST NORTH
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-5600
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Fax | 208-419-0202
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAMES CANNON ALLEN
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Credential | DDS
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Telephone | 208-356-5600
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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 | D-3634
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License Number State | ID
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