Provider Demographics
NPI:1093563355
Name:GALLATIN, ADAM ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:ROBERT
Last Name:GALLATIN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 GANDY BLVD N UNIT 1211
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2491
Mailing Address - Country:US
Mailing Address - Phone:937-242-2986
Mailing Address - Fax:
Practice Address - Street 1:18850 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4978
Practice Address - Country:US
Practice Address - Phone:813-949-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN297181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice