Provider Demographics
NPI:1548284615
Name:CARRELL, ALLEN F (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:F
Last Name:CARRELL
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 1:118 N BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-1206
Mailing Address - Country:US
Mailing Address - Phone:712-246-4391
Mailing Address - Fax:712-246-2921
Practice Address - Street 1:118 N BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1206
Practice Address - Country:US
Practice Address - Phone:712-246-4391
Practice Address - Fax:712-246-2921
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA72431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078758Medicaid
IA06049OtherBLUE CROSS BLUE SHEILD