Provider Demographics
NPI:1093092686
Name:FABRICE J GALLEZ, DDS, MS, INC
Entity Type:Organization
Organization Name:FABRICE J GALLEZ, DDS, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FABRICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:408-356-9366
Mailing Address - Street 1:2581 SAMARITAN DR
Mailing Address - Street 2:SUITE #310
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2581 SAMARITAN DR
Practice Address - Street 2:SUITE #310
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4113
Practice Address - Country:US
Practice Address - Phone:408-356-9366
Practice Address - Fax:408-356-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48268261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental