Provider Demographics
NPI:1720503519
Name:ALLEN, BRETT
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348-0248
Mailing Address - Country:US
Mailing Address - Phone:270-922-1063
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:HAWESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42348-2648
Practice Address - Country:US
Practice Address - Phone:270-927-6045
Practice Address - Fax:270-927-6859
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist