Provider Demographics
NPI:1821376765
Name:GAILLARD, DYLAN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:CHRISTOPHER
Last Name:GAILLARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3504
Mailing Address - Country:US
Mailing Address - Phone:402-980-2991
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist