Provider Demographics
NPI:1326109182
Name:ALLEN, ROBERT D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
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 1:11304 8TH AVENUE NORTHEAST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6111
Mailing Address - Country:US
Mailing Address - Phone:206-362-6677
Mailing Address - Fax:206-362-2586
Practice Address - Street 1:11304 8TH AVENUE NORTHEAST
Practice Address - Street 2:SUITE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6111
Practice Address - Country:US
Practice Address - Phone:206-362-6677
Practice Address - Fax:206-362-2586
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00003438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist