Provider Demographics
NPI:1730274259
Name:GREGALOT, JAMES L (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:GREGALOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 WOODCREST ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417
Mailing Address - Country:US
Mailing Address - Phone:561-968-1001
Mailing Address - Fax:561-968-4102
Practice Address - Street 1:4010 S 57TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-968-1001
Practice Address - Fax:561-968-4102
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0078621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZDA572OtherBLUE CROSS BLUE SHIELD
FL464674OtherANTHEM
FL467983OtherUNITED CONCORDIA
FL60170OtherBLUE CROSS BLUE SHIELD