Organization Name: | GREG GALLANT DMD LLC |
NPI Number: | 1225055312 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREG STEVIN GALLANT (DIRECTOR) |
Mailing Address: | 33 Clinton Rd Suite 106 West Caldwell |
State: | NJ US |
Postal Code: | 070066716 |
Phone Number: | 9732279211 |
Fax Number: | 9732279338 |
NPI Enumeration Date: | 07/16/2006 |
NPI Last Update Date: | 06/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 22DI01494000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |