Provider Demographics
NPI:1053405290
Name:ALLEN, MATTHEW J (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4508
Mailing Address - Country:US
Mailing Address - Phone:912-748-8585
Mailing Address - Fax:912-748-8505
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4508
Practice Address - Country:US
Practice Address - Phone:912-748-8585
Practice Address - Fax:912-748-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0126271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice