Provider Demographics
NPI:1235324377
Name:ALLEN, KENNETH J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S WABASH AVE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2897
Mailing Address - Country:US
Mailing Address - Phone:773-406-3347
Mailing Address - Fax:
Practice Address - Street 1:1440 S WABASH AVE
Practice Address - Street 2:UNIT 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2897
Practice Address - Country:US
Practice Address - Phone:773-406-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0274971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice