Organization
GAINESVILLE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL E. GANNON DMD (OWNER/DENTIST)
(770) 297-0401
Entity
Organization
Contact information
Practice address
426 SPRING ST, GAINESVILLE, GA 30501
(770) 297-0401
(770) 297-8477
Mailing address
426 SPRING ST, GAINESVILLE, GA 30501
(770) 297-0401
(770) 297-8477
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
DN013644
GA
1223D0001X
Public Health Dentistry
DN11839
GA
1223G0001X
General Practice Dentistry
Primary
DN013665
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00883099D
—
GA
Enumeration date
07/18/2008
Last updated
05/06/2024
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