Provider Demographics
NPI:1316153414
Name:ALLEN, JACK M (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:ALLEN
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:7373 WEST JEFFERSON AVENUE
Mailing Address - Street 2:SUITE #302
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2021
Mailing Address - Country:US
Mailing Address - Phone:303-988-9220
Mailing Address - Fax:303-988-9523
Practice Address - Street 1:7373 WEST JEFFERSON AVENUE
Practice Address - Street 2:SUITE #302
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2021
Practice Address - Country:US
Practice Address - Phone:303-988-9220
Practice Address - Fax:303-988-9523
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO3532122300000X
KS35321223X0400X
MO3071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics