Provider Demographics
NPI:1467691592
Name:GALLOUCIS, THERESE LOVWE (DMD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:LOVWE
Last Name:GALLOUCIS
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:HOWARD UNIVERSITY
Mailing Address - Street 2:600 W STREET NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20059-0001
Mailing Address - Country:US
Mailing Address - Phone:202-806-0068
Mailing Address - Fax:202-896-0354
Practice Address - Street 1:HOWARD UNIVERSITY
Practice Address - Street 2:600 W STREET NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-0001
Practice Address - Country:US
Practice Address - Phone:202-806-0068
Practice Address - Fax:202-896-0354
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist