Individual
DR. THOMAS J ALLEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1901 W WESTERN AVE, #B, SOUTH BEND, IN 46619-3521
(574) 234-9033
(574) 234-9059
Mailing address
20821 WHISPERING CREEK CT, SOUTH BEND, IN 46614-5172
(574) 291-5373
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88016N
DELTA DENTAL
IN
Enumeration date
09/06/2005
Last updated
07/08/2007
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