Provider Demographics
NPI:1780679878
Name:GALL, EDWARD DANIEL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DANIEL
Last Name:GALL
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:E.
Other - Middle Name:DANIEL
Other - Last Name:GALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12678 N YELLOW BIRD RD
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-7415
Mailing Address - Country:US
Mailing Address - Phone:520-797-5568
Mailing Address - Fax:
Practice Address - Street 1:2330 N ROSEMONT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2163
Practice Address - Country:US
Practice Address - Phone:520-327-0263
Practice Address - Fax:520-327-0965
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10996891223P0300X
AZD72161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics