Individual
GAVIN KALLABAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
26500 W HURON RIVER DR, FLAT ROCK, MI 48134-1135
(734) 782-3500
Mailing address
11 S MILL ST, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901601687
MI
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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