Organization
ALLRED DENTAL GROUP LLC
Active
Other names
Allred Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLI ANNE CARROLL (OFFICE MANAGER)
(706) 741-8433
Entity
Organization
Contact information
Practice address
743 S 8TH ST, GRIFFIN, GA 30224-4818
(770) 228-6101
(770) 228-6170
Mailing address
743 S 8TH ST, GRIFFIN, GA 30224-4818
(770) 228-6101
(770) 228-6170
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
010469
GA
302R00000X
Health Maintenance Organization
Primary
014067
GA
302R00000X
Health Maintenance Organization
014094
GA
302R00000X
Health Maintenance Organization
014960
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003162738C
—
GA
05
—
00727097A
—
GA
05
—
340647560A
—
GA
05
—
877225484A
—
GA
Enumeration date
02/01/2007
Last updated
09/16/2016
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