Provider Demographics
NPI:1972975944
Name:SHAWN ALLEN DDS, PC
Entity type:Organization
Organization Name:SHAWN ALLEN DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-355-3800
Mailing Address - Street 1:1402 HELDERBERG AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-4606
Mailing Address - Country:US
Mailing Address - Phone:518-355-3800
Mailing Address - Fax:518-355-3363
Practice Address - Street 1:1402 HELDERBERG AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-4606
Practice Address - Country:US
Practice Address - Phone:518-355-3800
Practice Address - Fax:518-355-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104921865OtherPERSONAL NPI NUMBER