Provider Demographics
NPI:1720310683
Name:ALLEN, DANIEL ARD (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ARD
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 1:4025 W BELL RD STE 13
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2750
Mailing Address - Country:US
Mailing Address - Phone:602-978-0200
Mailing Address - Fax:602-978-3162
Practice Address - Street 1:4025 W BELL RD STE 13
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2750
Practice Address - Country:US
Practice Address - Phone:602-978-0200
Practice Address - Fax:602-978-3162
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist