Healthcare Provider Details

I. General information

NPI: 1033037247
Provider Name (Legal Business Name): JOHN S GADALLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CARLTON DR
LEESBURG GA
31763-5652
US

IV. Provider business mailing address

119 CARLTON DR
LEESBURG GA
31763-5652
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-1726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: