Provider Demographics
NPI:1811191158
Name:ALLEN BROOK COMPREHENSIVE DENTAL, P.L.C
Entity Type:Organization
Organization Name:ALLEN BROOK COMPREHENSIVE DENTAL, P.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCALA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-878-7775
Mailing Address - Street 1:303 FORTY ACRE LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2114
Mailing Address - Country:US
Mailing Address - Phone:802-878-0979
Mailing Address - Fax:
Practice Address - Street 1:300 CORNERSTONE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4012
Practice Address - Country:US
Practice Address - Phone:802-878-7775
Practice Address - Fax:802-879-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00011751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0448Medicaid