Provider Demographics
NPI:1417166406
Name:GALLO, ROSALIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIA
Middle Name:
Last Name:GALLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2263
Mailing Address - Country:US
Mailing Address - Phone:203-264-9606
Mailing Address - Fax:203-264-4288
Practice Address - Street 1:250 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2263
Practice Address - Country:US
Practice Address - Phone:203-264-9606
Practice Address - Fax:203-264-4288
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice