Provider Demographics
NPI:1578213252
Name:ALLEN, CLARKE MONET (DDS)
Entity type:Individual
Prefix:
First Name:CLARKE
Middle Name:MONET
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 JEFFERSON ST NW APT 106
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7726
Mailing Address - Country:US
Mailing Address - Phone:601-813-7128
Mailing Address - Fax:
Practice Address - Street 1:100 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748-3842
Practice Address - Country:US
Practice Address - Phone:662-827-7400
Practice Address - Fax:662-827-7407
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4341-221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice