Provider Demographics
NPI:1578171948
Name:GALLES, NICHOLAS SAYERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SAYERS
Last Name:GALLES
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 1:44555 W EDISON RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6409
Mailing Address - Country:US
Mailing Address - Phone:520-759-3120
Mailing Address - Fax:520-759-3147
Practice Address - Street 1:44555 W EDISON RD STE A
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-6412
Practice Address - Country:US
Practice Address - Phone:520-759-3120
Practice Address - Fax:520-759-3147
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPD00271223G0001X
AZD0107731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice