Provider Demographics
NPI:1407875271
Name:ALLICK, HAROLD DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:DAVID
Last Name:ALLICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-881-6666
Mailing Address - Fax:301-881-2813
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-881-6666
Practice Address - Fax:301-881-2813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521613238OtherTAX ID#