Provider Demographics
NPI:1851757702
Name:GALLERIA DENTAL
Entity Type:Organization
Organization Name:GALLERIA DENTAL
Other - Org Name:ALABAMA DENTAL HOLDINGS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NEWDOME
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-988-5858
Mailing Address - Street 1:2801 HIGHWAY 150
Mailing Address - Street 2:SUITE 175T
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4007
Mailing Address - Country:US
Mailing Address - Phone:205-988-5858
Mailing Address - Fax:205-988-5886
Practice Address - Street 1:2801 HIGHWAY 150
Practice Address - Street 2:SUITE 175T
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4007
Practice Address - Country:US
Practice Address - Phone:205-988-5858
Practice Address - Fax:205-988-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty