Provider Demographics
NPI:1548309388
Name:STEVEN M GALLANT DDS PC
Entity type:Organization
Organization Name:STEVEN M GALLANT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-261-0610
Mailing Address - Street 1:309 E PACES FERRY ROAD
Mailing Address - Street 2:STE 602
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2319
Mailing Address - Country:US
Mailing Address - Phone:404-261-0610
Mailing Address - Fax:404-262-2338
Practice Address - Street 1:309 E PACES FERRY ROAD
Practice Address - Street 2:STE 602
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2319
Practice Address - Country:US
Practice Address - Phone:404-261-0610
Practice Address - Fax:404-262-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty