Provider Demographics
NPI:1376942466
Name:ALLEN PORTLAND DENTISTRY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ALLEN PORTLAND DENTISTRY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:361-854-7999
Mailing Address - Street 1:101 COX DR.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374
Mailing Address - Country:US
Mailing Address - Phone:361-643-0416
Mailing Address - Fax:361-643-3972
Practice Address - Street 1:101 COX DR.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374
Practice Address - Country:US
Practice Address - Phone:361-643-0416
Practice Address - Fax:361-643-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty