Provider Demographics
NPI:1841504818
Name:ALLEN, AUSTIN SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SCOTT
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 1:2123 BETHUNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-3808
Mailing Address - Country:US
Mailing Address - Phone:214-886-9957
Mailing Address - Fax:
Practice Address - Street 1:210 WILLOW ST NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5129
Practice Address - Country:US
Practice Address - Phone:828-572-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice