Provider Demographics
NPI:1245488238
Name:MORREALE, GARY T
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:T
Last Name:MORREALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SCHUYLKILL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5202
Mailing Address - Country:US
Mailing Address - Phone:610-933-7001
Mailing Address - Fax:610-983-9268
Practice Address - Street 1:300 SCHUYLKILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5202
Practice Address - Country:US
Practice Address - Phone:610-933-7001
Practice Address - Fax:610-983-9268
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026806L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics