Provider Demographics
NPI:1023058443
Name:ALLEN, JR., DALTON CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:CHARLES
Last Name:ALLEN, JR.
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 1:13301 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1327
Mailing Address - Country:US
Mailing Address - Phone:301-384-5457
Mailing Address - Fax:
Practice Address - Street 1:13301 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1327
Practice Address - Country:US
Practice Address - Phone:301-384-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC25751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice