MEDICARE: DR. SULLIVAN S GALLO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	033343	NY

General Provider Information

NPI Number	:	1356345003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SULLIVAN S GALLO DDS

Provider Business Mailing Address
First Line	:	228 MILL RD
Second Line	:	PO BOX 1268
City	:	WESTHAMPTON BEACH
State	:	NY
Zip	:	11978-2051
Country	:	US
Telephone Number	:	631-288-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 MILL RD
Second Line	:
City	:	WESTHAMPTON BEACH
State	:	NY
Zip	:	11978-2051
Country	:	US
Telephone Number	:	631-288-9232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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