Provider Demographics
NPI:1861701245
Name:GALLANT, THOMAS KEITH (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEITH
Last Name:GALLANT
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 1:8906 COLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4116
Mailing Address - Country:US
Mailing Address - Phone:301-589-2294
Mailing Address - Fax:301-589-2295
Practice Address - Street 1:8906 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4116
Practice Address - Country:US
Practice Address - Phone:301-589-2294
Practice Address - Fax:301-589-2295
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAG6770057OtherDEA