Provider Demographics
NPI:1326114950
Name:GALLEGOS, JOSE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
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 1:5424 SUNRISE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2516
Mailing Address - Country:US
Mailing Address - Phone:804-739-4972
Mailing Address - Fax:804-739-9543
Practice Address - Street 1:13861 HULL STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2003
Practice Address - Country:US
Practice Address - Phone:804-739-9190
Practice Address - Fax:804-739-9543
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice