Provider Demographics
NPI:1790869733
Name:GALLANOSA, ARNEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARNEL
Middle Name:J
Last Name:GALLANOSA
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 1:3750 N MERIDIAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4375
Mailing Address - Country:US
Mailing Address - Phone:317-506-2997
Mailing Address - Fax:317-506-2997
Practice Address - Street 1:3750 N MERIDIAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4375
Practice Address - Country:US
Practice Address - Phone:317-506-2997
Practice Address - Fax:317-506-2997
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009962A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200353150AMedicaid