Provider Demographics
NPI:1396796793
Name:ALLEN, JOHN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W 60TH ST #16A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8506
Mailing Address - Country:US
Mailing Address - Phone:917-608-0868
Mailing Address - Fax:212-523-2447
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:ST LUKES DIVISION OF ORAL & MAXILLOFACIAL SURGERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-523-3171
Practice Address - Fax:212-523-2447
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0003231223S0112X
NY052730122300000X, 204E00000X
CA46235122300000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered122300000XDental ProvidersDentist
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery