Provider Demographics
NPI:1972584803
Name:DEAN, ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:DEAN
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 1:4550 EUBANK BLVD NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3479
Mailing Address - Country:US
Mailing Address - Phone:505-292-2323
Mailing Address - Fax:505-292-2352
Practice Address - Street 1:4550 EUBANK BLVD NE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3479
Practice Address - Country:US
Practice Address - Phone:505-292-2323
Practice Address - Fax:505-292-2352
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0008954Medicare UPIN