Healthcare Provider Details

I. General information

NPI: 1376758318
Provider Name (Legal Business Name): ROBERT BENJAMIN ALLRED DMD, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 S 8TH ST
GRIFFIN GA
30224-4818
US

IV. Provider business mailing address

2935 HICKORY HILL RD
BROOKS GA
30205-2458
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-6101
  • Fax: 770-228-6170
Mailing address:
  • Phone: 706-993-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001004
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4929966-3902
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN014067
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: