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General NPI Number Information
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NPI Number | 1386830347
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Entity Type | Organization
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Legal Business Name | GALLO DENTAL CORPORATION
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Dates
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Enumeration Date | 09/23/2007
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Last Update Date | 09/23/2007
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Provider Practice Location Address
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Address Line | 5690 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-8332
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Country | US
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Telephone | 559-436-3470
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Fax | 559-436-3465
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Provider Business Mailing Address
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Address Line | 5690 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710-8332
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Country | US
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Telephone | 559-436-3470
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Fax | 559-436-3465
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | SUSAN NITTA
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Credential |
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Telephone | 559-436-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31040
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License Number State | MI
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