Provider Demographics
NPI:1811055148
Name:ALLEN, SHANAIL LYNNETTE MOORMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANAIL
Middle Name:LYNNETTE MOORMAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9455
Mailing Address - Country:US
Mailing Address - Phone:313-622-6345
Mailing Address - Fax:
Practice Address - Street 1:3225 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:TOANO
Practice Address - State:VA
Practice Address - Zip Code:23168-9455
Practice Address - Country:US
Practice Address - Phone:313-622-6345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014116591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice