Provider Demographics
NPI:1225055312
Name:GREG GALLANT DMD LLC
Entity Type:Organization
Organization Name:GREG GALLANT DMD LLC
Other - Org Name:GALLANT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:STEVIN
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-227-9211
Mailing Address - Street 1:33 CLINTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6716
Mailing Address - Country:US
Mailing Address - Phone:973-227-9211
Mailing Address - Fax:973-227-9338
Practice Address - Street 1:33 CLINTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6716
Practice Address - Country:US
Practice Address - Phone:973-227-9211
Practice Address - Fax:973-227-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01494000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental