Provider Demographics
NPI:1184763013
Name:ALLEN, EDWARD P (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 WALNUT HILL LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4216
Mailing Address - Country:US
Mailing Address - Phone:214-696-1414
Mailing Address - Fax:214-691-8174
Practice Address - Street 1:8335 WALNUT HILL LN
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4216
Practice Address - Country:US
Practice Address - Phone:214-696-1414
Practice Address - Fax:214-691-8174
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics