MEDICARE: DR. KAREN P GALLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7636	CT

General Provider Information

NPI Number	:	1629105796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN P GALLO

Provider Business Mailing Address
First Line	:	35 HIGH ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HIGH ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2315
Country	:	US
Telephone Number	:	203-467-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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