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General NPI Number Information
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NPI Number | 1801571500
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Entity Type | Individual
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Provider Name | REBECCA GAILLARD DMD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 5461 MERIDIAN MARK RD STE 200
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City | ATLANTA
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State | GA
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Zip | 30342-4014
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Country | US
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Telephone | 404-731-0503
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 IVY BROOK LN NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-4706
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Country | US
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Telephone | 404-731-0503
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123088
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License Number State | GA
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