Provider Demographics
NPI:1811021603
Name:ALLEN, DORIS J (DDS MPH)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3308
Mailing Address - Country:US
Mailing Address - Phone:734-998-9640
Mailing Address - Fax:734-998-9647
Practice Address - Street 1:406 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3308
Practice Address - Country:US
Practice Address - Phone:734-998-9640
Practice Address - Fax:734-998-9647
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015212122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4124033Medicaid
MID152120OtherBCBS OF MI DENTAL