STANTON CANNON ALLEN, DDS — NPI 1912963935 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in PROVIDENCE, UT)

CMS-1500 Box 24J / 33a • NPI

1912963935

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1223P0221X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

65 N. GATEWAY DRIVE, STE #1, PROVIDENCE, UT, 84332-6102

✓ 9-Digit EDI 837 ZIP+4 (84332-6102)

Practice Phone & Referral Fax

(435) 787-2223

Fax: (435) 752-9296

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1912963935 (STANTON CANNON ALLEN, DDS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1912963935` (NPI-1 Individual Practitioner)
Provider / Legal Name	STANTON CANNON ALLEN, DDS
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223P0221X` (Dentist, Pediatric Dentistry)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	65 N. GATEWAY DRIVE, STE #1, PROVIDENCE, UT, 84332-6102
Practice Telephone / Fax	Tel: (435) 787-2223 \| Fax: (435) 752-9296
Administrative Mailing Address	65 N. GATEWAY DRIVE, PROVIDENCE, UT, 84332-6102
Enumeration & Last Sync	Enumerated: 2006-04-26 \| CMS Record Updated: 2018-02-23

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

65 N. GATEWAY DRIVE, STE #1, PROVIDENCE, UT, 84332-6102

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Plain-English Taxonomy & CMS Crosswalk (1223P0221X)

What Does Taxonomy Code 1223P0221X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223P0221X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (STANTON CANNON ALLEN, DDS)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223P0221X` — Dentist, Pediatric Dentistry Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: UT \| License: `5854224` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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STANTON CANNON ALLEN, DDS (NPI #1912963935)