Basic Information
| Provider Information | |||||||||
| NPI: | 1508833542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | G3373 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | BURTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485291244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107436830 | ||||||||
| FaxNumber: | 8107437102 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485022045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107875001 | ||||||||
| FaxNumber: | 8104246029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901012613 | MI | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | BA3174909 | 01 | MI | DEA | OTHER |