1700842549 NPI number — MARK ALLEN DMD

Table of content: MARK ALLEN DMD (NPI 1700842549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700842549 NPI number — MARK ALLEN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700842549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
165 SHERMAN DRIVE
Provider Business Mailing Address City Name:
ST JOHNSBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05819-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-748-9405
Provider Business Mailing Address Fax Number:
802-748-4540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDWICK
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-472-2260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  160002025 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1006037 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com