Basic Information
| Provider Information | |||||||||
| NPI: | 1952503492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | ALEJANDRO | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 SUMMERWALK CIR | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275178677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192592034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MANNING DR COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661126 | ||||||||
| FaxNumber: | 9199666019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 150430 | NC | Y | Dental Providers | Dentist |
No ID Information.