# KENT J ALLEN/ SHANNON WIDMIER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PHEASANT COVE DENTAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770769325
- **Authorized official:** DR. KENT J ALLEN D.D.S. (OWNER)
- **Authorized official phone:** (208) 423-6444

## Contact information

- **Practice address:** 702 CENTER ST W, KIMBERLY, ID 83341
- **Practice address phone:** (208) 423-6444
- **Practice address fax:** (208) 423-6903
- **Mailing address:** 702 CENTER STREET WEST, PO BOX B, KIMBERLY, ID 83341
- **Mailing address phone:** (208) 423-6444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1767 | CA | Yes |

## Other

- **Enumeration date:** 01/14/2008
- **Last updated:** 01/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000876700 | — | ID |
| 01 | — | 9201818 | SMILES | ID |