Provider Demographics
NPI:1962531327
Name:DEATON, ALLEN BEE (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:BEE
Last Name:DEATON
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 1:1575 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8277
Mailing Address - Country:US
Mailing Address - Phone:920-426-2134
Mailing Address - Fax:
Practice Address - Street 1:155 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5674
Practice Address - Country:US
Practice Address - Phone:920-231-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK041931223G0001X
WI5554-0151223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice