Provider Demographics
NPI:1043443823
Name:ALLENANDALLENDENTAL & ASSOCIATES P.C
Entity Type:Organization
Organization Name:ALLENANDALLENDENTAL & ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:LAVELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-345-4444
Mailing Address - Street 1:P.O. BOX 252283
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-2283
Mailing Address - Country:US
Mailing Address - Phone:313-345-4444
Mailing Address - Fax:313-345-4106
Practice Address - Street 1:10720 W 7 MILE ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221
Practice Address - Country:US
Practice Address - Phone:313-345-4444
Practice Address - Fax:313-345-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010080681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty