Provider Demographics
NPI:1568507770
Name:ALLMON, BRADY L (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:L
Last Name:ALLMON
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 1:1405 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2273
Mailing Address - Country:US
Mailing Address - Phone:870-239-0606
Mailing Address - Fax:870-239-0909
Practice Address - Street 1:1205 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4133
Practice Address - Country:US
Practice Address - Phone:870-239-0808
Practice Address - Fax:870-239-0909
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice