Provider Demographics
NPI:1750339180
Name:KALAL, GREGORY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:KALAL
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 1:8621 WITHERSPOON CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4227
Mailing Address - Country:US
Mailing Address - Phone:907-339-1966
Mailing Address - Fax:907-339-1966
Practice Address - Street 1:724 POSTAL SERVICE LOOP
Practice Address - Street 2:#7500
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-5001
Practice Address - Country:US
Practice Address - Phone:907-384-3652
Practice Address - Fax:907-383-3647
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist