Provider Demographics
NPI:1356425979
Name:ALLEN, ROBERT GERARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:101 LYNCH CREEK WAY STE B
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8301
Mailing Address - Country:US
Mailing Address - Phone:707-769-1414
Mailing Address - Fax:707-769-1317
Practice Address - Street 1:101 LYNCH CREEK WAY STE B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8301
Practice Address - Country:US
Practice Address - Phone:707-769-1414
Practice Address - Fax:707-769-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA310151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology