Active NPI
Dandric Allen, DDS
- General Practice Dentistry
- Grand Prairie, TX
National Provider Identifier
1578656377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22250
- Practice address
- 2580 W Camp Wisdom Rd
Ste. 300
Grand Prairie, TX 75052-3088 - Phone
- (972) 522-0784
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22250 | TX | Primary |
Addresses
Primary practice location
2580 W Camp Wisdom Rd
Ste. 300
Grand Prairie, TX 75052-3088
Mailing address
2580 W Camp Wisdom Rd
Ste. 300
Grand Prairie, TX 75052-3088
Phone (972) 522-0784
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1734675-11 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22250 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327449600000",
"number": "1578656377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2580 W CAMP WISDOM RD",
"address_2": "STE. 300",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750523088",
"telephone_number": "972-522-0784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2580 W CAMP WISDOM RD",
"address_2": "STE. 300",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750523088",
"telephone_number": "972-522-0784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "DANDRIC",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2012-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "22250",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1734675-11",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.