Healthcare Provider Details

I. General information

NPI: 1962333948
Provider Name (Legal Business Name): ANDREA GALLION DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 S COTTON LN STE 100
GOODYEAR AZ
85338-4644
US

IV. Provider business mailing address

15550 W HARVARD ST APT 184
GOODYEAR AZ
85395-7583
US

V. Phone/Fax

Practice location:
  • Phone: 214-562-1116
  • Fax:
Mailing address:
  • Phone: 214-562-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: