Provider Demographics
NPI:1477625366
Name:ALLEN, JOANNE J (DDA)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2690
Mailing Address - Country:US
Mailing Address - Phone:505-293-7611
Mailing Address - Fax:505-296-1151
Practice Address - Street 1:4830 JUAN TABO NE
Practice Address - Street 2:SUITE K
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2682
Practice Address - Country:US
Practice Address - Phone:505-293-7611
Practice Address - Fax:505-296-1151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice