Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | D6993 | OR |
Y | 1223X0400X | Orthodontists | DE00007676 | WA |
NPI | 1023031879 |
---|---|
Provider Name | Dr. Trevor W. Allen |
First Address | Camas, WA 98607-2013 |
Second Address | Camas, WA 98607-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |