Organization
FIRST CITY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J ALLEN DDS (OWNER)
(912) 385-4134
Entity
Organization
Contact information
Practice address
1000 TOWNE CENTER BLVD BLDG 100 STE 101, POOLER, GA 31322-4508
(912) 385-4134
Mailing address
1000 TOWNE CENTER BLVD BLDG 100, STE 101, POOLER, GA 31322-4508
(912) 385-4134
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
10/10/2019
Last updated
11/10/2021
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