Provider Demographics
NPI:1578701157
Name:VERGEN, ALLEN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MICHAEL
Last Name:VERGEN
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 1:501 N PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2445
Mailing Address - Country:US
Mailing Address - Phone:912-632-0872
Mailing Address - Fax:912-632-0886
Practice Address - Street 1:501 N PIERCE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2445
Practice Address - Country:US
Practice Address - Phone:912-632-0872
Practice Address - Fax:912-632-0886
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice