Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D7328 | AZ |
N | 1223D0001X | Dental Public Health | D7328 | AZ |
NPI | 1740480029 |
---|---|
Provider Name | Dr. Michael D Allen |
First Address | Sahuarita, AZ 85629-8887 |
Second Address | Nogales, AZ 85621-1063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 13/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227533 | (05) | AZ |