Provider Demographics
NPI:1063021723
Name:ALLEN, NATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SPRING LOOP APT 1308
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2186
Mailing Address - Country:US
Mailing Address - Phone:503-705-0480
Mailing Address - Fax:
Practice Address - Street 1:11671 FM 2154 RD STE 400
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4796
Practice Address - Country:US
Practice Address - Phone:979-399-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL250461223G0001X
TX364351223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice