Provider Demographics
NPI:1396963054
Name:ALLEN, MARK A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 COUNTY RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4464
Mailing Address - Country:US
Mailing Address - Phone:775-782-9177
Mailing Address - Fax:775-782-2007
Practice Address - Street 1:1701 COUNTY RD
Practice Address - Street 2:SUITE K
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4464
Practice Address - Country:US
Practice Address - Phone:775-782-9177
Practice Address - Fax:775-782-2007
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 27841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice