Provider Demographics
NPI:1003976739
Name:GALLIEN, THOMAS WALKER SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALKER
Last Name:GALLIEN
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3340
Mailing Address - Country:US
Mailing Address - Phone:731-587-6066
Mailing Address - Fax:731-587-4312
Practice Address - Street 1:145 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3340
Practice Address - Country:US
Practice Address - Phone:731-587-6066
Practice Address - Fax:731-587-4312
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS21791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice