Thomas J Allen, D.D.S.
Individual provider Active NPI Dentist · South Bend, IN
NPI 1679567739 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1679567739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12007316A (IN)
- Practice address
- 1901 W Western Ave
#B
South Bend, IN 46619-3521 - Phone
- (574) 234-9033
- Fax
- (574) 234-9059
- NPI assigned
- Sep 6, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 12007316A | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12007316A | IN | Yes |
Addresses
Primary practice location
1901 W Western Ave
#B
South Bend, IN 46619-3521
Mailing address
20821 Whispering Creek CT
South Bend, IN 46614-5172
Phone (574) 291-5373
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 88016N | Other | IN | DELTA DENTAL |
Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. 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.