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General NPI Number Information
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NPI Number | 1467840892
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Entity Type | Organization
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Legal Business Name | G. ALLEN D.D.S., AND N. BALACHANDRAN D.D.S., INC
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 955 BOARDWALK SUITE 301
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City | SAN MARCOS
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State | CA
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Zip | 92078-2659
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Country | US
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Telephone | 760-593-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 955 BOARDWALK SUITE 301
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City | SAN MARCOS
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State | CA
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Zip | 92078-2659
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Country | US
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Telephone | 760-593-4640
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGORY PHILIP ALLEN II
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Credential | D.D.S
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Telephone | 760-593-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 56992
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License Number State | CA
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