Provider Demographics
NPI:1194395558
Name:GALLOWITZ, CANDACE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:
Last Name:GALLOWITZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 IMPERIAL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3492
Mailing Address - Country:US
Mailing Address - Phone:615-822-0833
Mailing Address - Fax:615-590-7943
Practice Address - Street 1:107 IMPERIAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3492
Practice Address - Country:US
Practice Address - Phone:615-822-0833
Practice Address - Fax:615-590-7943
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN116331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice