Provider Demographics
NPI:1194964411
Name:ALLRED, JEFFREY GLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GLEN
Last Name:ALLRED
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 1:955 BOARDWALK
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2659
Mailing Address - Country:US
Mailing Address - Phone:760-304-6455
Mailing Address - Fax:760-481-7155
Practice Address - Street 1:955 BOARDWALK
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2659
Practice Address - Country:US
Practice Address - Phone:760-304-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7089890-9922122300000X
CA58336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist