Provider Demographics
NPI:1003430570
Name:ALLEN DENTAL, PLLC
Entity Type:Organization
Organization Name:ALLEN DENTAL, PLLC
Other - Org Name:ALLEN DENTAL,PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-947-7193
Mailing Address - Street 1:15 1ST ST NE STE 207151
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9275
Mailing Address - Country:US
Mailing Address - Phone:406-466-5662
Mailing Address - Fax:406-466-5861
Practice Address - Street 1:15 1ST ST NE STE 207151
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9275
Practice Address - Country:US
Practice Address - Phone:406-466-5662
Practice Address - Fax:406-466-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT516171750Medicaid