Healthcare Provider Details

I. General information

NPI: 1639884463
Provider Name (Legal Business Name): GALLEGOS ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 MONTGOMERY BLVD NE BLDG CB
ALBUQUERQUE NM
87109-1531
US

IV. Provider business mailing address

7520 MONTGOMERY BLVD NE BLDG CB
ALBUQUERQUE NM
87109-1531
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-6902
  • Fax:
Mailing address:
  • Phone: 505-881-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN WALSH GALLEGOS
Title or Position: OWNER/MANAGER
Credential: DDS
Phone: 505-331-6939