Provider Demographics
NPI:1679797781
Name:KONIS, ALLEN BERNARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:BERNARD
Last Name:KONIS
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 1:1050 NW 15TH ST
Mailing Address - Street 2:103A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-392-2025
Mailing Address - Fax:561-392-2025
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:103A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-392-2025
Practice Address - Fax:561-392-2025
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice