Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D11882 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | 49648 | MN |
NPI | 1295700383 |
---|---|
Provider Name | Dr. Benjamin E Allen |
First Address | Edina, MN 55435-2131 |
Second Address | Edina, MN 55435-2131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
647671600 | (05) | MN |
U98325 | (02) |