Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN013148 | GA |
NPI | 1053413906 |
---|---|
Provider Name | Nelson Allen |
First Address | Atlanta, GA 30342-4014 |
Second Address | Atlanta, GA 30342-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 25/06/2021 |