Provider Demographics
NPI:1326608662
Name:GADALLA, SHEREF (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEREF
Middle Name:
Last Name:GADALLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 LIMESTONE LN UNIT 21-105
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3240
Mailing Address - Country:US
Mailing Address - Phone:732-862-7751
Mailing Address - Fax:
Practice Address - Street 1:5442 THOMASVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-7598
Practice Address - Country:US
Practice Address - Phone:850-427-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0421731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice