Active NPI
Marla J Allen
- Dentist
- Ft Walton Beach, FL
National Provider Identifier
1760588016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11210
- Practice address
- 136A Staff Drive
Ft Walton Beach, FL 32548 - Phone
- (850) 243-5668
- Fax
- (850) 243-6890
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 11210 | FL | Primary |
Addresses
Primary practice location
136A Staff Drive
Ft Walton Beach, FL 32548
Mailing address
136A Staff Drive
Ft Walton Beach, FL 32548
Phone (850) 243-5668
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 |
|---|---|---|---|
| 11210 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760588016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136A STAFF DRIVE",
"city": "FT WALTON BEACH",
"state": "FL",
"postal_code": "32548",
"telephone_number": "850-243-5668",
"fax_number": "850-243-6890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136A STAFF DRIVE",
"city": "FT WALTON BEACH",
"state": "FL",
"postal_code": "32548",
"telephone_number": "850-243-5668",
"fax_number": "850-243-6890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "MARLA",
"middle_name": "J",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "11210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.