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General NPI Number Information
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NPI Number | 1225055312
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Entity Type | Organization
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Legal Business Name | GREG GALLANT DMD LLC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 33 CLINTON RD SUITE 106
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-6716
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Country | US
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Telephone | 973-227-9211
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Fax | 973-227-9338
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Provider Business Mailing Address
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Address Line | 33 CLINTON RD SUITE 106
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-6716
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Country | US
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Telephone | 973-227-9211
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Fax | 973-227-9338
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GREG STEVIN GALLANT
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Credential | D.M.D.
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Telephone | 973-227-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI01494000
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License Number State | NJ
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