Provider Demographics
NPI:1326178427
Name:ALLEN, DAVID C (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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 1:435 HICKORY POINTE
Mailing Address - Street 2:APT # 3
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305
Mailing Address - Country:US
Mailing Address - Phone:217-641-3018
Mailing Address - Fax:
Practice Address - Street 1:407 SO 48TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-9102
Practice Address - Country:US
Practice Address - Phone:217-228-9467
Practice Address - Fax:217-228-0131
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice