Provider Demographics
NPI:1891426235
Name:ALLEN, ROBERT CHRISTIAAN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTIAAN
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 E JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7483
Mailing Address - Country:US
Mailing Address - Phone:480-589-5528
Mailing Address - Fax:
Practice Address - Street 1:1060 S HARRISON RD STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6603
Practice Address - Country:US
Practice Address - Phone:520-917-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZFA1804637122300000X
AZD011510122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist