Provider Demographics
NPI:1043210065
Name:GALL, ANDREW RODES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RODES
Last Name:GALL
Suffix:
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 1:132 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7474
Mailing Address - Country:US
Mailing Address - Phone:970-245-1758
Mailing Address - Fax:970-245-1759
Practice Address - Street 1:132 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7474
Practice Address - Country:US
Practice Address - Phone:970-245-1758
Practice Address - Fax:970-245-1759
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6467332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1376365OtherTIM