Provider Demographics
NPI:1326242298
Name:DALLAS, NATHAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:J
Last Name:DALLAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9422
Mailing Address - Country:US
Mailing Address - Phone:229-573-7122
Mailing Address - Fax:
Practice Address - Street 1:2206 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3279
Practice Address - Country:US
Practice Address - Phone:229-883-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA135651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice