Provider Demographics
NPI:1386866598
Name:ALLEN, ANDREW L (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2217
Mailing Address - Country:US
Mailing Address - Phone:207-729-6721
Mailing Address - Fax:207-729-1411
Practice Address - Street 1:117 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2217
Practice Address - Country:US
Practice Address - Phone:207-729-6721
Practice Address - Fax:207-729-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics