Provider Demographics
NPI:1245374446
Name:ALLEN, MARSHALL TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:TODD
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 1:1263 W GONZALES RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3364
Mailing Address - Country:US
Mailing Address - Phone:805-485-5478
Mailing Address - Fax:
Practice Address - Street 1:1263 W GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3364
Practice Address - Country:US
Practice Address - Phone:805-485-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics