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General NPI Number Information
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NPI Number | 1598157364
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Entity Type | Organization
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Legal Business Name | MATTHEW J. ALLEN, D.D.S., L.L.C.
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 1000 TOWNE CENTER BLVD SUITE 101
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City | POOLER
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State | GA
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Zip | 31322-4052
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Country | US
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Telephone | 912-748-8585
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Fax | 912-748-8505
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Provider Business Mailing Address
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Address Line | 1000 TOWNE CENTER BLVD SUITE 101
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City | POOLER
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State | GA
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Zip | 31322-4052
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Country | US
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Telephone | 912-748-8585
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Fax | 912-748-8505
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW J ALLEN
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Credential | DDS
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Telephone | 912-748-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012627
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License Number State | GA
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