Provider Demographics
NPI:1457504573
Name:GALLO DENTAL CARE, LLC
Entity Type:Organization
Organization Name:GALLO DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:URREGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-534-6933
Mailing Address - Street 1:950 WASHINGTON ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3542
Mailing Address - Country:US
Mailing Address - Phone:770-534-6933
Mailing Address - Fax:770-535-7882
Practice Address - Street 1:950 WASHINGTON ST
Practice Address - Street 2:SUITE J
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3542
Practice Address - Country:US
Practice Address - Phone:770-534-6933
Practice Address - Fax:770-535-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013677261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental