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NPI Code Detail

MEDICARE: GWINNETT FAMILY DENTAL CARE

MEDICARE: GWINNETT FAMILY DENTAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistGA11839GA

General Provider Information

NPI Number : 1316112360
Entity Type Code : Organization
Provider Name (Legal Business Name) : GWINNETT FAMILY DENTAL CARE
Provider Business Mailing Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number : 770-564-3856
Provider Business Practice Location Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number : 770-564-3856
Authorized Official
Title or Position : OWNER
Name : DR. KELL D. GALLAHER
Credential : DMD
Telephone Number : 770-921-1115
Provider Enumeration Date : 04/29/2008
Last Update Date : 04/30/2008

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Directions to “GWINNETT FAMILY DENTAL CARE ” Practice Location

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