Provider Demographics
NPI:1396759312
Name:ALLEN, WILLIAM R (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:ALLEN
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:5426 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3685
Mailing Address - Country:US
Mailing Address - Phone:719-548-1711
Mailing Address - Fax:719-548-1252
Practice Address - Street 1:5426 N ACADEMY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3685
Practice Address - Country:US
Practice Address - Phone:719-548-1711
Practice Address - Fax:719-548-1252
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO70121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics