Provider Demographics
NPI:1487868006
Name:ALLEN, WARREN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:THOMAS
Last Name:ALLEN
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 1:3756 SANTA ROSALIA DR.
Mailing Address - Street 2:224
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3616
Mailing Address - Country:US
Mailing Address - Phone:323-294-6187
Mailing Address - Fax:323-294-4282
Practice Address - Street 1:3756 SANTA ROSALIA DR.
Practice Address - Street 2:224
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3616
Practice Address - Country:US
Practice Address - Phone:323-294-6187
Practice Address - Fax:323-294-4282
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice