Provider Demographics
NPI:1265658983
Name:GALLOWAY, RODGER A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:A
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 1:227 W 2ND ST
Mailing Address - Street 2:P.O. BOX 1355
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8124
Mailing Address - Country:US
Mailing Address - Phone:425-888-2330
Mailing Address - Fax:
Practice Address - Street 1:227 W 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8124
Practice Address - Country:US
Practice Address - Phone:425-888-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice