Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 4066 | AL |
NPI | 1376707869 |
---|---|
Provider Name | Dr. Dale Edwin Allen |
First Address | Madison, AL 35758-1435 |
Second Address | Madison, AL 35758-1435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 14/07/2008 |