Provider Demographics
NPI:1841373289
Name:ALLEN, JEFFREY FRANK (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:FRANK
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 1:839 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219
Mailing Address - Country:US
Mailing Address - Phone:641-628-1121
Mailing Address - Fax:641-620-1035
Practice Address - Street 1:839 BROADWAY
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-628-1121
Practice Address - Fax:641-620-1035
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA72271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24843OtherBLUE CROSS BLUE SHIELD
PA969500OtherUNITED CONCORDIA
IA1138305Medicaid