=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205232295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLAN L LINK DMD & ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2014
-----------------------------------------------------
Last Update Date | 08/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14335 MANCHESTER RD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-4048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-496-8584
-----------------------------------------------------
Fax | 314-894-3980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14335 MANCHESTER RD
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-4048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-894-9711
-----------------------------------------------------
Fax | 314-894-3980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | DR. ALLAN LENNOX LINK III
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 314-540-0658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13564
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------