Provider Demographics
NPI:1710350996
Name:ROBERT A. GALLEGOS, DDS, PC
Entity Type:Organization
Organization Name:ROBERT A. GALLEGOS, DDS, PC
Other - Org Name:MIDDLEBURG SMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-687-6363
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-0386
Mailing Address - Country:US
Mailing Address - Phone:540-687-6363
Mailing Address - Fax:540-687-6733
Practice Address - Street 1:204 E. FEDERAL ST.
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117
Practice Address - Country:US
Practice Address - Phone:540-687-6363
Practice Address - Fax:540-687-6733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty