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General NPI Number Information
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NPI Number | 1720172240
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Entity Type | Individual
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Provider Name | ELIZABETH T GALLEGLY DDS
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 18251 ROSCOE BLVD STE 201A 18251 ROSCOE BLVD., STE. 201A
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4254
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Country | US
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Telephone | 818-700-1247
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Fax | 818-885-0762
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Provider Business Mailing Address
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Address Line | 18251 ROSCOE BLVD STE 201A
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4254
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Country | US
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Telephone | 818-700-1247
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Fax | 818-885-0762
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44528
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License Number State | CA
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