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General NPI Number Information
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NPI Number | 1699111682
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Entity Type | Organization
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Legal Business Name | GALLO-MICHLES PROFESSIONAL DENTAL CORP.
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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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 |
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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 |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | XOCHITL ESPARZA
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Credential |
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Telephone | 619-220-7495
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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 | 19777
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License Number State | CA
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