Provider Demographics
NPI:1982968848
Name:ALLEN, STACI ROBINSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACI
Middle Name:ROBINSON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 DALE ROAD, SUITE 305
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-5008
Mailing Address - Country:US
Mailing Address - Phone:860-674-8417
Mailing Address - Fax:
Practice Address - Street 1:44 DALE RD STE 305
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4351
Practice Address - Country:US
Practice Address - Phone:860-674-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057851-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid