Provider Demographics
NPI:1629799515
Name:GALLA PIMENTEL, OBED RABSARIS (DDS)
Entity Type:Individual
Prefix:
First Name:OBED
Middle Name:RABSARIS
Last Name:GALLA PIMENTEL
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 1:8707 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1450
Mailing Address - Country:US
Mailing Address - Phone:269-235-4753
Mailing Address - Fax:
Practice Address - Street 1:1817 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6103
Practice Address - Country:US
Practice Address - Phone:269-487-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013931A122300000X
MI2901601633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist