Provider Demographics
NPI:1700373602
Name:DYLAN C GAILLARD, DDS, LLC
Entity Type:Organization
Organization Name:DYLAN C GAILLARD, DDS, LLC
Other - Org Name:GEORGETOWNE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-330-6080
Mailing Address - Street 1:2526 S 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2339
Mailing Address - Country:US
Mailing Address - Phone:402-333-6080
Mailing Address - Fax:402-333-5024
Practice Address - Street 1:2526 S 140TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2339
Practice Address - Country:US
Practice Address - Phone:402-333-6080
Practice Address - Fax:402-333-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental