Healthcare Provider Details

I. General information

NPI: 1346356375
Provider Name (Legal Business Name): JAVIER JOSE GALLARDO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 AVE COMERIO LEVITTOWN
TOA BAJA PR
00949-4067
US

IV. Provider business mailing address

28 CAMINO DEL MERLIN SABANERA
DORADO PR
00646-3455
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-8110
  • Fax:
Mailing address:
  • Phone: 787-460-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2529
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: