Provider Demographics
NPI:1124571021
Name:GALLOWAY, NATHANIEL ABRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ABRAM
Last Name:GALLOWAY
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 1:1314 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5740
Mailing Address - Country:US
Mailing Address - Phone:210-712-8654
Mailing Address - Fax:
Practice Address - Street 1:4400 N MIDKIFF RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4219
Practice Address - Country:US
Practice Address - Phone:432-689-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice