Samuel Brooks Allen, D.D.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Downers Grove, IL
NPI 1033567359 · NPPES record last updated May 26, 2016
Key facts
- NPI
- 1033567359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 19030584 (IL)
- Practice address
- 6800 Main St., Third Floor
Downers Grove, IL 60516 - Phone
- (630) 969-5350
- Fax
- (630) 969-4692
- NPI assigned
- May 26, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 3, 2019 through Jan 3, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19030584 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grove Dental Associates., P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 19030584 | IL | Yes |
Addresses
Primary practice location
6800 Main St., Third Floor
Downers Grove, IL 60516
Mailing address
6800 Main St., Third Floor
Downers Grove, IL 60516
Phone (630) 969-5350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19030584 | Other | IL | LICENSE |
Other providers in Downers Grove, IL
- Diamond Alexander
- Yazan M Alia
- Bianca C Alianello
- Alivio Dental Care, LLC
- Colleen M Allen
- Allergy Ear Nose Throat,LTD
- Kirk P Alley
- Alliance Ambulance LLC
- Kevin Donald Allibone
- Allied Alpha Assistants, Inc
All providers in Downers Grove, IL · Orthodontics and Dentofacial Orthopedics Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.