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NPI Code Detail

MEDICARE: GAVIN KALLABAT DMD

MEDICARE: GAVIN KALLABAT DMD
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
11223G0001XGeneral Practice Dentistry2901601687MI

General Provider Information

NPI Number : 1376237388
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAVIN KALLABAT DMD
Provider Business Mailing Address
First Line : 11 S MILL ST
Second Line :
City : NEW CASTLE
State : PA
Zip : 16101-3680
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26500 W HURON RIVER DR
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1135
Country : US
Telephone Number : 734-782-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2023
Last Update Date : 06/05/2023

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Directions to “ GAVIN KALLABAT DMD” Practice Location

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