Provider Demographics
NPI:1457547713
Name:ALLARD, MICHAEL G (DDSMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:ALLARD
Suffix:
Gender:M
Credentials:DDSMD
Other - Prefix:
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Mailing Address - Street 1:18555 N 79TH AVE
Mailing Address - Street 2:#A103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8370
Mailing Address - Country:US
Mailing Address - Phone:623-412-0310
Mailing Address - Fax:623-412-2188
Practice Address - Street 1:18555 N 79TH AVE
Practice Address - Street 2:A103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8370
Practice Address - Country:US
Practice Address - Phone:623-412-0310
Practice Address - Fax:623-412-2188
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD53141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery