Individual provider Active NPI

Bruce A Gallant, D.D.S.

  • Dentist
  • Sterling Heights, MI
National Provider Identifier
1780606269
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D9838 Issued in MI
Practice address
11453 15 Mile Rd
Sterling Heights, MI 48312-3809
Phone
(586) 939-3333
Fax
(586) 939-8183
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D9838 MI Primary

Addresses

Primary practice location

11453 15 Mile Rd
Sterling Heights, MI 48312-3809

Mailing address

11453 15 Mile Rd
Sterling Heights, MI 48312-3809
Phone (586) 939-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150610001516 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3476513011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D9838MIMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780606269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11453 15 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483123809",
            "telephone_number": "586-939-3333",
            "fax_number": "586-939-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11453 15 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483123809",
            "telephone_number": "586-939-3333",
            "fax_number": "586-939-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLANT",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "D9838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

Verify at the official NPI Registry.