Healthcare Provider Details

I. General information

NPI: 1780679878
Provider Name (Legal Business Name): EDWARD DANIEL GALL III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: E. DANIEL GALL D.D.S.

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N ROSEMONT BLVD SUITE A
TUCSON AZ
85712-2163
US

IV. Provider business mailing address

12678 N YELLOW BIRD RD
ORO VALLEY AZ
85755-7415
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-0263
  • Fax: 520-327-0965
Mailing address:
  • Phone: 520-797-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1099689
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD7216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: