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General NPI Number Information
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NPI Number | 1780121798
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Entity Type | Organization
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Legal Business Name | DR. THOMAS J. ALLEN PC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 4020 S 700 E SUITE 4
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2186
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Country | US
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Telephone | 801-266-4352
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 982902
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City | PARK CITY
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State | UT
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Zip | 84098-2902
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Country | US
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Telephone |
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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. THOMAS JAMES ALLEN
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Credential | DDS
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Telephone | 210-602-9831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9332582-9921
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License Number State | UT
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