Individual
GREGORY LEE GULLIKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1853 KNOX MCRAE DR, TITUSVILLE, FL 32780-5492
(321) 267-2934
(321) 267-3698
Mailing address
1853 KNOX MCRAE DR, TITUSVILLE, FL 32780-5492
(321) 267-2934
(321) 267-3698
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0011987
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63699
BCBS PROVIDER NUMBER
FL
Enumeration date
08/18/2006
Last updated
07/08/2007
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