Provider Demographics
NPI:1912963935
Name:ALLEN, STANTON CANNON (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:CANNON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:65 N. GATEWAY DRIVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-6102
Mailing Address - Country:US
Mailing Address - Phone:435-787-2223
Mailing Address - Fax:435-752-9296
Practice Address - Street 1:65 N. GATEWAY DRIVE
Practice Address - Street 2:STE #1
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-6102
Practice Address - Country:US
Practice Address - Phone:435-787-2223
Practice Address - Fax:435-752-9296
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT58542241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry