Provider Demographics
NPI:1659787331
Name:ALBERTO GALLASTEGUI D.D.S. INC.
Entity Type:Organization
Organization Name:ALBERTO GALLASTEGUI D.D.S. INC.
Other - Org Name:WEST PARK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:GALLASTEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-554-0513
Mailing Address - Street 1:1701 N MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2745
Mailing Address - Country:US
Mailing Address - Phone:714-554-0513
Mailing Address - Fax:714-554-9020
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2745
Practice Address - Country:US
Practice Address - Phone:714-554-0513
Practice Address - Fax:714-554-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty