Healthcare Provider Details

I. General information

NPI: 1972523884
Provider Name (Legal Business Name): ROBERT A. GALLEGOS, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E FEDERAL ST
MIDDLEBURG VA
20118-0386
US

IV. Provider business mailing address

PO BOX 386 204 E FEDERAL STREET
MIDDLEBURG VA
20118-0386
US

V. Phone/Fax

Practice location:
  • Phone: 540-687-6363
  • Fax: 540-687-6733
Mailing address:
  • Phone: 540-687-6363
  • Fax: 540-687-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6392
License Number StateVA

VIII. Authorized Official

Name: DR. ROBERT ALAN GALLEGOS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 540-687-6363