Provider Demographics
NPI:1578858536
Name:ALLEGRE, BRAD (DMD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:ALLEGRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E MAIDEN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3737
Mailing Address - Country:US
Mailing Address - Phone:624-222-0380
Mailing Address - Fax:724-222-8808
Practice Address - Street 1:1145 E MAIDEN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3737
Practice Address - Country:US
Practice Address - Phone:624-222-0380
Practice Address - Fax:724-222-8808
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0386711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice