Provider Demographics
NPI:1003464009
Name:ALLEN, JACOB MILLER (DDS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MILLER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 COUNTY ROAD 2360
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-3211
Mailing Address - Country:US
Mailing Address - Phone:903-441-4121
Mailing Address - Fax:
Practice Address - Street 1:930 COUNTY ROAD 2360
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-3211
Practice Address - Country:US
Practice Address - Phone:903-441-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist