Provider Demographics
NPI:1205943024
Name:GALLET, MICHAEL ELLIS (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELLIS
Last Name:GALLET
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 1:1020 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2988
Mailing Address - Country:US
Mailing Address - Phone:908-654-6140
Mailing Address - Fax:908-654-2773
Practice Address - Street 1:1020 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2988
Practice Address - Country:US
Practice Address - Phone:908-654-6140
Practice Address - Fax:908-654-2773
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist