Provider Demographics
NPI:1477998821
Name:ALLEN, MATTHEW FREDERICK (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FREDERICK
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 COLONIAL PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3897
Mailing Address - Country:US
Mailing Address - Phone:770-993-6666
Mailing Address - Fax:
Practice Address - Street 1:565 COLONIAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3897
Practice Address - Country:US
Practice Address - Phone:770-993-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice