NPIMap

Organization Active NPI

Allen Dental Group LLC

  • Dentist
  • Eagle River, AK
National Provider Identifier
1124365622
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1327 Issued in AK
Legal business name
ALLEN DENTAL GROUP LLC
Practice address
17101 Snowmobile LN
Suite 107
Eagle River, AK 99577-7043
Phone
(907) 622-6233
Fax
(907) 622-6232
NPI assigned
Jan 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bradford C. Allen, DDSNPI 1548294192
Title
Owner/Member
Phone
(907) 622-6233

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 1327 AK Primary

Addresses

Primary practice location

17101 Snowmobile LN
Suite 107
Eagle River, AK 99577-7043

Mailing address

17101 Snowmobile LN
Suite 107
Eagle River, AK 99577-7043
Phone (907) 622-6233

National Provider Directory

National Provider Directory

Locations

17101 Snowmobile Ln
Ste 107
Eagle River, AK 99577
Phone (907) 622-6233

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357257600000",
    "number": "1124365622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17101 SNOWMOBILE LN",
            "address_2": "SUITE 107",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777043",
            "telephone_number": "907-622-6233",
            "fax_number": "907-622-6232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17101 SNOWMOBILE LN",
            "address_2": "SUITE 107",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777043",
            "telephone_number": "907-622-6233",
            "fax_number": "907-622-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEN DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-04",
        "last_updated": "2013-01-04",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "907-622-6233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "1327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.