Provider Demographics
NPI:1154636033
Name:SMITH, ALLEN DENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DENE
Last Name:SMITH
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 1:45 CAPRI BLVD SUITE G
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5657
Mailing Address - Country:US
Mailing Address - Phone:650-291-0068
Mailing Address - Fax:
Practice Address - Street 1:45 CAPRI BLVD SUITE G
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU
Practice Address - State:AZ
Practice Address - Zip Code:86403-5657
Practice Address - Country:US
Practice Address - Phone:650-291-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023313122300000X
AZD010799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist