MEDICARE: PASQUALE J GALLELLI DMD PC

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	DS024316L	PA

General Provider Information

NPI Number	:	1811007776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASQUALE J GALLELLI DMD PC

Provider Business Mailing Address
First Line	:	1815 SO BROAD STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148
Country	:	US
Telephone Number	:	215-462-6229
Fax Number	:	215-467-9080

Provider Business Practice Location Address
First Line	:	1815 SO BROAD STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148
Country	:	US
Telephone Number	:	215-462-6229
Fax Number	:	215-467-9080

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. PASQUALE J GALLELLI
Credential	:	DMD PC
Telephone Number	:	215-462-6229

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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