Provider Demographics
NPI:1346433695
Name:ALLEN, DANIELLA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E LINDEN AVE
Mailing Address - Street 2:APT #14D
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3632
Mailing Address - Country:US
Mailing Address - Phone:201-541-9380
Mailing Address - Fax:
Practice Address - Street 1:330 RIDGE RD
Practice Address - Street 2:MAC ARTHUR RIDGE PLAZA
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3613
Practice Address - Country:US
Practice Address - Phone:201-818-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023596001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice