NPIMap

Individual provider Active NPI

Michael Jay Allen, DDS

  • Endodontics
  • Roseburg, OR
National Provider Identifier
1689851636
Registry record updated Jan 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
D8752 Issued in OR
Practice address
1813 W Harvard Avenue
Suite 240
Roseburg, OR 97470
Phone
(541) 440-9175
Fax
(541) 673-1246
NPI assigned
Jan 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X D8752 OR Primary

Addresses

Primary practice location

1813 W Harvard Avenue
Suite 240
Roseburg, OR 97470

Mailing address

1813 W Harvard Avenue
Suite 240
Roseburg, OR 97470
Phone (541) 440-9175

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

LicenseStateTypeSpecialty
D8752ORMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Umpqua Endodontics Endodontics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200960000000",
    "number": "1689851636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVENUE",
            "address_2": "SUITE 240",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97470",
            "telephone_number": "541-440-9175",
            "fax_number": "541-673-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVENUE",
            "address_2": "SUITE 240",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "97470",
            "telephone_number": "541-440-9175",
            "fax_number": "541-673-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-22",
        "last_updated": "2008-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D8752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; 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.