Provider Demographics
NPI:1891904397
Name:GALLASTEGUI, ALBERTO (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:GALLASTEGUI
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 1:27702 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE A2
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0608
Mailing Address - Country:US
Mailing Address - Phone:714-334-3021
Mailing Address - Fax:
Practice Address - Street 1:27702 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0608
Practice Address - Country:US
Practice Address - Phone:949-365-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55606OtherSTATE LICENSE