Provider Demographics
NPI:1598880635
Name:ALLEN, JEFFREY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
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 1:929 S ALPINE RD
Mailing Address - Street 2:STE #407
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3990
Mailing Address - Country:US
Mailing Address - Phone:815-398-6545
Mailing Address - Fax:815-398-6541
Practice Address - Street 1:929 S ALPINE RD
Practice Address - Street 2:STE #407
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3990
Practice Address - Country:US
Practice Address - Phone:815-398-6545
Practice Address - Fax:815-398-6541
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A159511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice