Provider Demographics
NPI:1639132715
Name:GALLEGOS, MICHAEL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:GALLEGOS
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 1:5 CALLE MEDICO
Mailing Address - Street 2:SUITE-D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4762
Mailing Address - Country:US
Mailing Address - Phone:505-995-0718
Mailing Address - Fax:505-984-3056
Practice Address - Street 1:5 CALLE MEDICO
Practice Address - Street 2:SUITE-D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4762
Practice Address - Country:US
Practice Address - Phone:505-995-0718
Practice Address - Fax:505-984-3056
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice