Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30-014914 | OH |
NPI | 1811079668 |
---|---|
Provider Name | Dr. Carl Michael Allen |
First Address | Westerville, OH 43082-7647 |
Second Address | Westerville, OH 43082-7647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0504896 | (05) | OH |
T47430 | (02) | OH |