NPIMap

Organization Active NPI

Gregory L Gullikson DMD PA

  • Dentist
  • Titusville, FL
National Provider Identifier
1982085296
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN11987 Issued in FL
Legal business name
GREGORY L GULLIKSON DMD PA
Practice address
1853 Knox McRae Dr
Titusville, FL 32780-5492
Phone
(321) 267-2934
Fax
(321) 267-3698
NPI assigned
Jun 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Gregory Lee Gullikson, DMDNPI 1851405732
Title
Dentist
Phone
(321) 267-2934

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN11987 FL Primary

Addresses

Primary practice location

1853 Knox McRae Dr
Titusville, FL 32780-5492

Mailing address

1853 Knox McRae Dr
Titusville, FL 32780-5492
Phone (321) 267-2934

National Provider Directory

National Provider Directory

Locations

1853 Knox McRae Dr
Titusville, FL 32780
Phone (321) 267-2934

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1982085296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1853 KNOX MCRAE DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805492",
            "telephone_number": "321-267-2934",
            "fax_number": "321-267-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1853 KNOX MCRAE DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805492",
            "telephone_number": "321-267-2934",
            "fax_number": "321-267-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY L GULLIKSON DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "GULLIKSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "321-267-2934",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN11987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.