Provider Demographics
NPI:1356936173
Name:DORA ELENA GALLEGO DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:DORA ELENA GALLEGO DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DORA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-206-5938
Mailing Address - Street 1:12321 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5319
Mailing Address - Country:US
Mailing Address - Phone:201-919-8061
Mailing Address - Fax:
Practice Address - Street 1:12321 OAK KNOLL RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5319
Practice Address - Country:US
Practice Address - Phone:201-919-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental