Provider Demographics
NPI:1992753933
Name:J MICHAEL ALLEN DDS PC
Entity type:Organization
Organization Name:J MICHAEL ALLEN DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-684-2044
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-0289
Mailing Address - Country:US
Mailing Address - Phone:402-694-2044
Mailing Address - Fax:402-694-6244
Practice Address - Street 1:1219 N ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-0289
Practice Address - Country:US
Practice Address - Phone:402-694-2044
Practice Address - Fax:402-694-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4441126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025101900Medicaid