Provider Demographics
NPI:1356345003
Name:GALLO, SULLIVAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:SULLIVAN
Middle Name:S
Last Name:GALLO
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 1:228 MILL RD
Mailing Address - Street 2:PO BOX 1268
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-2051
Mailing Address - Country:US
Mailing Address - Phone:631-288-9232
Mailing Address - Fax:
Practice Address - Street 1:228 MILL RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2051
Practice Address - Country:US
Practice Address - Phone:631-288-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice