Healthcare Provider Details

I. General information

NPI: 1316778970
Provider Name (Legal Business Name): DOMINIC GALLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1613
US

IV. Provider business mailing address

7808 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1613
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-6789
  • Fax: 858-598-6720
Mailing address:
  • Phone: 858-598-6789
  • Fax: 858-598-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: