Provider Demographics
NPI:1861586513
Name:ALLEN, DAVID JUDD (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JUDD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CHALKSTONE ST NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806
Mailing Address - Country:US
Mailing Address - Phone:601-594-6661
Mailing Address - Fax:
Practice Address - Street 1:111 PARK PLACE DR STE F
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4252
Practice Address - Country:US
Practice Address - Phone:256-489-1431
Practice Address - Fax:256-403-2496
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2163-851223G0001X
TN89761223G0001X
AL56651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice