Provider Demographics
NPI:1124069604
Name:ALLEN, JAMES D (DDS, FACP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1177 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4223
Mailing Address - Country:US
Mailing Address - Phone:615-690-5400
Mailing Address - Fax:615-690-5404
Practice Address - Street 1:1177 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4223
Practice Address - Country:US
Practice Address - Phone:615-690-5400
Practice Address - Fax:615-690-5404
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000044271223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN461361OtherUNITED CONCORDIA PROVIDER
TN0163882OtherBCBS PROVIDER ID NUMBER