Provider Demographics
NPI:1023031879
Name:ALLEN, TREVOR W (DMD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2013
Mailing Address - Country:US
Mailing Address - Phone:360-834-5171
Mailing Address - Fax:360-833-8439
Practice Address - Street 1:736 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2013
Practice Address - Country:US
Practice Address - Phone:360-834-5171
Practice Address - Fax:360-833-8439
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000076761223X0400X
ORD69931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics