Provider Demographics
NPI:1407385339
Name:ALLEN, CAROLYN B (DMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
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 1:5021 NW 34TH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1191
Mailing Address - Country:US
Mailing Address - Phone:229-834-6659
Mailing Address - Fax:
Practice Address - Street 1:5021 NW 34TH BLVD STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1191
Practice Address - Country:US
Practice Address - Phone:229-834-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist