Organization
WEST GEORGIA DENTAL OF LA GRANGE,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA MILLIGAN ALLEN DDS (PRESIDENT)
(706) 812-8220
Entity
Organization
Contact information
Practice address
1555 DOCTORS DR STE 105, LAGRANGE, GA 30240-4132
(706) 812-8220
(706) 812-8218
Mailing address
1555 DOCTORS DR STE 105, LAGRANGE, GA 30240-4132
(706) 812-8220
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011455
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100198
AVESIS/PEACHSTATE
GA
01
—
167795
DORAL/WELLCARE
GA
Enumeration date
07/11/2006
Last updated
08/22/2020
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