Basic Information
| Provider Information | |||||||||
| NPI: | 1417010323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3 | ||||||||
| Address2: | |||||||||
| City: | PLUMMER | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838510003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088743251 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3919 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992051349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094448200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D3098 | ID | N | Dental Providers | Dentist | 122300000X | DE00005149 | WA | Y | Dental Providers | Dentist |
No ID Information.