Provider Demographics
NPI:1811073984
Name:ALLEN, DANDRIDGE BERRY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANDRIDGE
Middle Name:BERRY
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-0087
Mailing Address - Country:US
Mailing Address - Phone:540-955-2220
Mailing Address - Fax:540-955-4025
Practice Address - Street 1:100 CHALMERS CT
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1347
Practice Address - Country:US
Practice Address - Phone:540-955-2220
Practice Address - Fax:540-955-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010043681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice