Jason David Allan, DDS
Individual provider Active NPI Dentist · Orem, UT
NPI 1114296019 · NPPES record last updated Dec 21, 2011
Key facts
- NPI
- 1114296019
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6250598 (UT)
- Practice address
- 1176 S 1480 W
Orem, UT 84058-4905 - Phone
- (801) 426-0774
- Fax
- (801) 224-5437
- NPI assigned
- Dec 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6250598 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| College Dental Clinic LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6250598 | UT | Yes |
Addresses
Primary practice location
1176 S 1480 W
Orem, UT 84058-4905
Mailing address
1176 S 1480 W
Orem, UT 84058-4905
Phone (801) 426-0774
Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.