Provider Demographics
NPI:1760564017
Name:ALLEN, DENNIS PARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PARK
Last Name:ALLEN
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 1:4490 WORTHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1161
Mailing Address - Country:US
Mailing Address - Phone:727-787-3718
Mailing Address - Fax:
Practice Address - Street 1:138 COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3704
Practice Address - Country:US
Practice Address - Phone:727-937-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice