Provider Demographics
NPI:1871786806
Name:ALLEN, CHENETA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHENETA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHENETA
Other - Middle Name:
Other - Last Name:ALLEN-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1103 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1863
Mailing Address - Country:US
Mailing Address - Phone:336-641-3152
Mailing Address - Fax:336-641-5859
Practice Address - Street 1:1103 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1863
Practice Address - Country:US
Practice Address - Phone:336-641-3152
Practice Address - Fax:336-641-5859
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902UHMedicaid