Healthcare Provider Details

I. General information

NPI: 1942136841
Provider Name (Legal Business Name): MICHAEL T ALLEN DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N CHURCH ST
THOMASTON GA
30286-3611
US

IV. Provider business mailing address

419 N CHURCH ST
THOMASTON GA
30286-3611
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-7111
  • Fax: 706-646-9692
Mailing address:
  • Phone: 706-647-7111
  • Fax: 706-646-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLENDA ALLEN
Title or Position: OFFICE MANAER
Credential: SPOUSE
Phone: 706-975-6429