Provider Demographics
NPI:1669711123
Name:ALLEN, JOHN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
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 1:1219 N ST
Mailing Address - Street 2:P. O. BOX 289
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1621
Mailing Address - Country:US
Mailing Address - Phone:402-694-2044
Mailing Address - Fax:
Practice Address - Street 1:1219 N ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1621
Practice Address - Country:US
Practice Address - Phone:402-694-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE193200000XMedicaid