Provider Demographics
NPI:1194724963
Name:ALLEN, DAVID J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5276
Mailing Address - Country:US
Mailing Address - Phone:630-668-0197
Mailing Address - Fax:
Practice Address - Street 1:116 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5276
Practice Address - Country:US
Practice Address - Phone:630-668-0197
Practice Address - Fax:630-668-0548
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0177521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics