Provider Demographics
NPI:1891871273
Name:ALLEN, JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:464 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4606
Mailing Address - Country:US
Mailing Address - Phone:860-443-3634
Mailing Address - Fax:860-444-7861
Practice Address - Street 1:464 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4606
Practice Address - Country:US
Practice Address - Phone:860-443-3634
Practice Address - Fax:860-444-7861
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice