Provider Demographics
NPI:1376758318
Name:ALLRED, ROBERT BENJAMIN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:ALLRED
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-2458
Mailing Address - Country:US
Mailing Address - Phone:706-993-6695
Mailing Address - Fax:
Practice Address - Street 1:743 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4818
Practice Address - Country:US
Practice Address - Phone:770-228-6101
Practice Address - Fax:770-228-6170
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001004106H00000X
UT4929966-3902106H00000X
GADN014067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist