Provider Demographics
NPI:1700811692
Name:ALLEN, JACQUELINE SAVANNAH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SAVANNAH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 N 7TH AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1173
Mailing Address - Country:US
Mailing Address - Phone:602-242-4745
Mailing Address - Fax:602-246-4778
Practice Address - Street 1:6520 N 7TH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1173
Practice Address - Country:US
Practice Address - Phone:602-242-4745
Practice Address - Fax:602-246-4778
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics