Provider Demographics
NPI:1831109487
Name:GALLO, DONALD ALFRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALFRED
Last Name:GALLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13195 SW 134TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4461
Mailing Address - Country:US
Mailing Address - Phone:305-274-2499
Mailing Address - Fax:305-274-6086
Practice Address - Street 1:15501 NW 67TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2108
Practice Address - Country:US
Practice Address - Phone:786-577-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice