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General NPI Number Information
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NPI Number | 1366962474
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Entity Type | Individual
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Provider Name | JESSICA KING GALECIO
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 409 ETTER DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1073
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Country | US
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Telephone | 859-887-1094
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Fax | 859-885-1604
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Provider Business Mailing Address
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Address Line | 409 ETTER DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1073
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Country | US
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Telephone | 859-887-1094
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Fax | 859-885-1604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9971
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License Number State | KY
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