Provider Demographics
NPI:1841672193
Name:ALLEN, BRYN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:BRYN
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 TURNSTILE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2259
Mailing Address - Country:US
Mailing Address - Phone:253-722-3558
Mailing Address - Fax:
Practice Address - Street 1:1971 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7820
Practice Address - Country:US
Practice Address - Phone:843-871-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist