Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 052730 | NY |
N | 122300000X | Dentist | 46235 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DNF000323 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 052730 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 46235 | CA |
NPI | 1396796793 |
---|---|
Provider Name | Dr. John Michael Allen |
First Address | New York, NY 10023-8506 |
Second Address | New York, NY 10025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |