Provider Demographics
NPI:1184634206
Name:GALLEGOS, ANTHONY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:GALLEGOS
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 1:4915 YORBA RANCH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2508
Mailing Address - Country:US
Mailing Address - Phone:714-777-8884
Mailing Address - Fax:714-777-5973
Practice Address - Street 1:4915 YORBA RANCH RD
Practice Address - Street 2:SUITE C
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2508
Practice Address - Country:US
Practice Address - Phone:714-777-8884
Practice Address - Fax:714-777-5973
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0330871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice