Provider Demographics
NPI:1982036315
Name:GALLA, THOMAS V (DMD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:V
Last Name:GALLA
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 1:5690 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3565
Mailing Address - Country:US
Mailing Address - Phone:814-836-0667
Mailing Address - Fax:814-836-9746
Practice Address - Street 1:5690 PERRY HWY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3565
Practice Address - Country:US
Practice Address - Phone:814-836-0667
Practice Address - Fax:814-836-9746
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017619L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist