Provider Demographics
NPI:1013032226
Name:GALLO, JOSEPH L
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:GALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 N BUFFALO RD STE 6
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4211 N BUFFALO RD STE 6
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2401
Practice Address - Country:US
Practice Address - Phone:716-662-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-08-08
Deactivation Date:2016-08-01
Deactivation Code:
Reactivation Date:2016-08-08
Provider Licenses
StateLicense IDTaxonomies
NY044660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist