Provider Demographics
NPI:1639884463
Name:GALLEGOS ENDODONTICS LLC
Entity Type:Organization
Organization Name:GALLEGOS ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALSH
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-331-6939
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG CB
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1531
Mailing Address - Country:US
Mailing Address - Phone:505-881-6902
Mailing Address - Fax:
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG CB
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1531
Practice Address - Country:US
Practice Address - Phone:505-881-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty