Provider Demographics
NPI:1851576581
Name:GALLOWAY DENTAL, PC
Entity Type:Organization
Organization Name:GALLOWAY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:ORUP
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-986-8846
Mailing Address - Street 1:66 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1719
Mailing Address - Country:US
Mailing Address - Phone:845-986-8846
Mailing Address - Fax:845-986-0925
Practice Address - Street 1:66 GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1719
Practice Address - Country:US
Practice Address - Phone:845-986-8846
Practice Address - Fax:845-986-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty