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General NPI Number Information
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NPI Number | 1457504573
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Entity Type | Organization
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Legal Business Name | GALLO DENTAL CARE, LLC
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 950 WASHINGTON ST SUITE J
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City | GAINESVILLE
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State | GA
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Zip | 30501-3542
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Country | US
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Telephone | 770-534-6933
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Fax | 770-535-7882
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Provider Business Mailing Address
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Address Line | 950 WASHINGTON ST SUITE J
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City | GAINESVILLE
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State | GA
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Zip | 30501-3542
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Country | US
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Telephone | 770-534-6933
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Fax | 770-535-7882
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIA P. URREGO
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Credential | D.D.S
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Telephone | 770-534-6933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN013677
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License Number State | GA
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