Provider Demographics
NPI:1649326307
Name:ALLEN, THOMAS B (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
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 1:2033 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4707
Mailing Address - Country:US
Mailing Address - Phone:201-944-9392
Mailing Address - Fax:201-944-3044
Practice Address - Street 1:2033 CENTER AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4707
Practice Address - Country:US
Practice Address - Phone:201-944-9392
Practice Address - Fax:201-944-3044
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ98811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics