Provider Demographics
NPI:1346255049
Name:ALLEN, DARCY M (DDS)
Entity type:Individual
Prefix:DR
First Name:DARCY
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12317 WINCHESTER RD. SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:240-803-3487
Mailing Address - Fax:
Practice Address - Street 1:12317 WINCHESTER RD SW STE 100
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6547
Practice Address - Country:US
Practice Address - Phone:240-803-3487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0372293Medicaid