Healthcare Provider Details

I. General information

NPI: 1255499349
Provider Name (Legal Business Name): ANTHONY A GALLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PROSPECT HILL RD
EAST WINDSOR CT
06088
US

IV. Provider business mailing address

518 HIGH ROAD
KENSINGTON CT
06037
US

V. Phone/Fax

Practice location:
  • Phone: 860-192-6600
  • Fax:
Mailing address:
  • Phone: 860-192-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCT6880
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: