Provider Demographics
NPI:1508948316
Name:DR ALLAN T BACON II DDS PA
Entity Type:Organization
Organization Name:DR ALLAN T BACON II DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:THOMSON
Authorized Official - Last Name:BACON
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-791-0333
Mailing Address - Street 1:1329 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3107
Mailing Address - Country:US
Mailing Address - Phone:301-791-0333
Mailing Address - Fax:301-791-0337
Practice Address - Street 1:1329 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3107
Practice Address - Country:US
Practice Address - Phone:301-791-0333
Practice Address - Fax:301-791-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD58391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty