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General NPI Number Information
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NPI Number | 1386774057
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Entity Type | Individual
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Provider Name | JEREMY W ALLEN DMD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 908 W 5TH ST SUITE 114
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City | LONDON
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State | KY
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Zip | 40741-2417
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Country | US
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Telephone | 606-330-0330
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Fax | 606-877-8836
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Provider Business Mailing Address
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Address Line | 908 W 5TH ST SUITE 114
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City | LONDON
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State | KY
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Zip | 40741-2417
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Country | US
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Telephone | 606-330-0330
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Fax | 606-877-8836
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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 | 8365
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License Number State | KY
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