Individual
BRANDON IRA ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1508 OXFORD DR, GEORGETOWN, KY 40324-9266
(502) 863-0880
(502) 867-7363
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 863-0880
(502) 867-7363
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8056
KY
1223G0001X
General Practice Dentistry
Primary
8056
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100053320
—
KY
Enumeration date
08/23/2006
Last updated
02/26/2015
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