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General NPI Number Information
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NPI Number | 1568504868
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Entity Type | Organization
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Legal Business Name | LSUHSC SCHOOL OF DENTISTRY
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 1100 FLORIDA AVENUE
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2714
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Country | US
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Telephone | 504-941-8110
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Fax | 504-941-8117
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Provider Business Mailing Address
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Address Line | 1100 FLORIDA AVENUE
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City | NEW ORLEANS
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State | LA
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Zip | 70119-2714
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Country | US
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Telephone | 504-941-8110
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Fax | 504-941-8112
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Authorized Official
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Title or Position | ASSISTANT DEAN OF CLINICAL AFFAIRS
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Name | DR. JOHN GALLO
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Credential | D.D.S.
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Telephone | 504-941-8110
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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 | 4618
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License Number State | LA
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