MEDICARE: DR. DAVID LAWRENCE ALLEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6180	OK

General Provider Information

NPI Number	:	1417278078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LAWRENCE ALLEN D.D.S.

Provider Business Mailing Address
First Line	:	2401 NW 23RD ST
Second Line	:	SUITE 23
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2442
Country	:	US
Telephone Number	:	405-942-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 NW 23RD ST
Second Line	:	SUITE 23
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2442
Country	:	US
Telephone Number	:	405-942-0337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/15/2013

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