MEDICARE: DR. SALVADOR EBREO GALES DMD

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	042597	NY

General Provider Information

NPI Number	:	1720062383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALVADOR EBREO GALES DMD

Provider Business Mailing Address
First Line	:	11806 ROCKAWAY BLVD FL 1
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2420
Country	:	US
Telephone Number	:	718-843-0263
Fax Number	:	718-843-0045

Provider Business Practice Location Address
First Line	:	11806 ROCKAWAY BLVD
Second Line	:
City	:	SOUTH OZONE PARK
State	:	NY
Zip	:	11420-2420
Country	:	US
Telephone Number	:	718-843-0263
Fax Number	:	718-843-0045

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	10/23/2019

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