Individual
GRANT GALLUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3909 NEWBERRY RD STE G, GAINESVILLE, FL 32607-2367
(352) 371-9831
Mailing address
8313 SW 77TH AVE, GAINESVILLE, FL 32608-8464
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
26932
FL
Other
Enumeration date
06/14/2022
Last updated
06/14/2022
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