Provider Demographics
NPI:1942210661
Name:GALES, ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:GALES
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 1:1823 SOMERVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5015
Mailing Address - Country:US
Mailing Address - Phone:256-355-2275
Mailing Address - Fax:
Practice Address - Street 1:1823 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5015
Practice Address - Country:US
Practice Address - Phone:256-355-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009906070Medicaid
AL631069848OtherTAX ID
AL1347699OtherUNITED CONCORDIA
AL51500214OtherBCBS OF AL