Provider Demographics
NPI:1699787507
Name:ALLEN, WILLIAM BAILEY (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BAILEY
Last Name:ALLEN
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:PO BOX 30338
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0006
Mailing Address - Country:US
Mailing Address - Phone:931-647-4184
Mailing Address - Fax:931-552-2944
Practice Address - Street 1:2041 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6621
Practice Address - Country:US
Practice Address - Phone:931-647-4184
Practice Address - Fax:931-552-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS32151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice