Provider Demographics
NPI:1194806778
Name:ALLEN, BRANDON (DDS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4219
Mailing Address - Country:US
Mailing Address - Phone:804-780-2888
Mailing Address - Fax:804-643-1916
Practice Address - Street 1:300 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4219
Practice Address - Country:US
Practice Address - Phone:804-780-2888
Practice Address - Fax:804-643-1916
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice