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NPI Code Detail

MEDICARE: DR. KRISTON GALLIPEAU

MEDICARE: DR. KRISTON GALLIPEAU
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
11223G0001XGeneral Practice Dentistry45573CA

General Provider Information

NPI Number : 1821125410
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTON GALLIPEAU
Provider Business Mailing Address
First Line : 305 WALNUT AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4904
Country : US
Telephone Number : 619-291-1181
Fax Number : 619-291-0316
Provider Business Practice Location Address
First Line : 305 WALNUT AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4904
Country : US
Telephone Number : 619-291-1181
Fax Number : 619-291-0316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/08/2007

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Directions to “ DR. KRISTON GALLIPEAU ” Practice Location

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