Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS0000004427 | TN |
NPI | 1124069604 |
---|---|
Provider Name | Dr. James D. Allen |
First Address | Brentwood, TN 37027-4223 |
Second Address | Brentwood, TN 37027-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0163882 | BCBS PROVIDER ID NUMBER (01) | TN |
461361 | UNITED CONCORDIA PROVIDER (01) | TN |