Provider Demographics
NPI:1902056161
Name:ALLEN FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:ALLEN FAMILY DENTISTRY, LLC
Other - Org Name:ALLEN DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:PARK
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-937-5159
Mailing Address - Street 1:138 COUNTRY CLUB CT
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3704
Mailing Address - Country:US
Mailing Address - Phone:727-937-5159
Mailing Address - Fax:727-937-5109
Practice Address - Street 1:138 COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3704
Practice Address - Country:US
Practice Address - Phone:727-937-5159
Practice Address - Fax:727-937-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5617122300000X
FL14250122300000X
FL17222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty