MEDICARE: ROBERT J. GALLIEN, DDS, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1952771172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J. GALLIEN, DDS, PLLC

Provider Business Mailing Address
First Line	:	4618 HIGHWAY 58
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37416-3013
Country	:	US
Telephone Number	:	423-894-5725
Fax Number	:	423-321-8775

Provider Business Practice Location Address
First Line	:	4618 HIGHWAY 58
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37416-3013
Country	:	US
Telephone Number	:	423-894-5725
Fax Number	:	423-321-8775

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT J GALLIEN
Credential	:	D.D.S.
Telephone Number	:	423-894-5725

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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