Provider Demographics
NPI:1508693383
Name:ALLEN, ANDREA MARLE (DMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 GARDEN BELLE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9561
Mailing Address - Country:US
Mailing Address - Phone:727-599-5461
Mailing Address - Fax:
Practice Address - Street 1:1151 BLACKWOOD AVE STE 130
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4519
Practice Address - Country:US
Practice Address - Phone:407-523-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist