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General NPI Number Information
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NPI Number | 1912189382
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Entity Type | Organization
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Legal Business Name | CHARLES D. ALLEN, JR., DDS, PA
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 508 MCKAY ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0235
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Country | US
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Telephone | 910-862-4334
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Fax | 910-862-3813
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Provider Business Mailing Address
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Address Line | PO BOX 235 508 MCKAY ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-0235
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Country | US
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Telephone | 910-862-4334
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Fax | 910-862-3813
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES DAVIS ALLEN JR.
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Credential | DDS
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Telephone | 910-862-4334
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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 | 3762
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License Number State | NC
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