Provider Demographics
NPI:1598953325
Name:GALLO, PAUL V (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:GALLO
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 1:3077 W JEFFERSON STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-741-2752
Mailing Address - Fax:815-741-9020
Practice Address - Street 1:3077 W JEFFERSON STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-741-2752
Practice Address - Fax:815-741-9020
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist