Provider Demographics
NPI:1982351771
Name:ALLRED DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALLRED DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-304-6455
Mailing Address - Street 1:955 BOARDWALK STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2659
Mailing Address - Country:US
Mailing Address - Phone:760-304-6455
Mailing Address - Fax:760-290-3608
Practice Address - Street 1:955 BOARDWALK STE 201
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2659
Practice Address - Country:US
Practice Address - Phone:760-304-6455
Practice Address - Fax:760-290-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery