Provider Demographics
NPI:1053800904
Name:ALLEN, JORDAN KIT (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:KIT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9558
Mailing Address - Country:US
Mailing Address - Phone:740-374-7060
Mailing Address - Fax:740-374-0023
Practice Address - Street 1:319 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9558
Practice Address - Country:US
Practice Address - Phone:740-374-7060
Practice Address - Fax:740-374-0023
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0253681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice