Provider Demographics
NPI:1164719290
Name:ALLEN, JESSICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SHRECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MSD
Mailing Address - Street 1:2610 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2869
Mailing Address - Country:US
Mailing Address - Phone:702-270-4600
Mailing Address - Fax:
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2869
Practice Address - Country:US
Practice Address - Phone:702-270-4600
Practice Address - Fax:702-270-7773
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4-891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics