Healthcare Provider Details

I. General information

NPI: 1598011405
Provider Name (Legal Business Name): KISLEY GALLO ROMANO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CITY CENTER BLVD STE 2E
NEWPORT NEWS VA
23606-1880
US

IV. Provider business mailing address

106 JOY CT
YORKTOWN VA
23693-3143
US

V. Phone/Fax

Practice location:
  • Phone: 915-615-9607
  • Fax:
Mailing address:
  • Phone: 915-615-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415103
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: