Staci Robinson Allen, DDS
Individual provider Active NPI Pediatric Dentistry · Avon, CT
NPI 1982968848 · NPPES record last updated Apr 12, 2017
Key facts
- NPI
- 1982968848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 057851-1 (NY)
- Practice address
- 44 Dale Rd Ste 305
Avon, CT 06001-4351 - Phone
- (860) 674-8417
- NPI assigned
- Jun 26, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 057851-1 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dental Center of Avon, LLC | Pediatric Dentistry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 057851-1 | NY | Yes |
Addresses
Primary practice location
44 Dale Rd Ste 305
Avon, CT 06001-4351
Mailing address
44 Dale Road, Suite 305
Avon, CT 06001-5008
Phone (860) 674-8417
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004011136 | Medicaid | CT |
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- Emily H Allen
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- Alliance Treatment Center
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- Altruism Psychcare Center
- Briana Jean Anderson
All providers in Avon, CT · Pediatric Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2017. 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.