Provider Demographics
NPI:1639345036
Name:CLARIDA, GALE E (DMD)
Entity Type:Individual
Prefix:MRS
First Name:GALE
Middle Name:E
Last Name:CLARIDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4205
Mailing Address - Country:US
Mailing Address - Phone:770-394-3920
Mailing Address - Fax:770-393-0741
Practice Address - Street 1:1651 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4205
Practice Address - Country:US
Practice Address - Phone:770-394-3920
Practice Address - Fax:770-393-0741
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist