Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401008461 | VA |
N | 122300000X | Dentist | DE00008439 | WA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 4806 | OR |
NPI | 1447364914 |
---|---|
Provider Name | Dr. Gary Wayne Allen |
First Address | Redmond, OR 97756-7039 |
Second Address | Redmond, OR 97756-7039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 03/07/2017 |