Provider Demographics
NPI:1588948194
Name:BACON, ALLAN THOMSON III (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:THOMSON
Last Name:BACON
Suffix:III
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 1:1329 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3157
Mailing Address - Country:US
Mailing Address - Phone:301-791-0333
Mailing Address - Fax:301-791-0337
Practice Address - Street 1:1329 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3157
Practice Address - Country:US
Practice Address - Phone:301-791-0333
Practice Address - Fax:301-791-0337
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice