Provider Demographics
NPI:1770217028
Name:DANIEL ALLEN, DMD, MSD, LLC
Entity Type:Organization
Organization Name:DANIEL ALLEN, DMD, MSD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:317-517-7422
Mailing Address - Street 1:680 E 56TH ST STE I
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7777
Mailing Address - Country:US
Mailing Address - Phone:317-852-8113
Mailing Address - Fax:317-852-8115
Practice Address - Street 1:680 E 56TH ST STE I
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7777
Practice Address - Country:US
Practice Address - Phone:317-852-8113
Practice Address - Fax:317-852-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300036174Medicaid