Provider Demographics
NPI:1912189382
Name:CHARLES D. ALLEN, JR., DDS, PA
Entity Type:Organization
Organization Name:CHARLES D. ALLEN, JR., DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-862-4334
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:508 MCKAY ST
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0235
Mailing Address - Country:US
Mailing Address - Phone:910-862-4334
Mailing Address - Fax:910-862-3813
Practice Address - Street 1:508 MCKAY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-0235
Practice Address - Country:US
Practice Address - Phone:910-862-4334
Practice Address - Fax:910-862-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty