| NPI | 1275175309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW J ALLEN Owner 912-385-4134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2021-11-10 |