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General NPI Number Information
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NPI Number | 1386894384
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Entity Type | Individual
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Provider Name | GERALDINE OCAMPO GALLANT D.D,S,
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Gender | Female
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 1448 SOUTHBOUND GRATIOT AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-6533
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Country | US
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Telephone | 586-954-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 74 OXFORD RD
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City | GROSSE POINTE SHORES
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State | MI
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Zip | 48236-1829
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Country | US
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Telephone | 313-882-6870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901016818
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License Number State | MI
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