Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN014573 | GA |
NPI | 1578701157 |
---|---|
Provider Name | Dr. Allen Michael Vergen |
First Address | Alma, GA 31510-2445 |
Second Address | Alma, GA 31510-2445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 27/02/2015 |