Provider Demographics
NPI:1164508230
Name:ALLEN, HAYDEN PARK (DDS)
Entity type:Individual
Prefix:DR
First Name:HAYDEN
Middle Name:PARK
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2837
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice