Provider Demographics
NPI:1407818487
Name:ALLEN, HARVEY WALDO
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:WALDO
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FALL HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3564
Mailing Address - Country:US
Mailing Address - Phone:540-373-2350
Mailing Address - Fax:540-373-7782
Practice Address - Street 1:1701 FALL HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3564
Practice Address - Country:US
Practice Address - Phone:540-373-2350
Practice Address - Fax:540-373-7782
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380000021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery