Provider Demographics
NPI:1669548103
Name:GALLEGOS, SIDNEY R (DDS)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:R
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:SIDNEY R GALLEGOS DDS PS
Mailing Address - Street 2:926 S 348TH
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-924-0717
Mailing Address - Fax:253-925-1439
Practice Address - Street 1:SIDNEY R GALLEGOS DDS PS
Practice Address - Street 2:926 S 348TH
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-924-0717
Practice Address - Fax:253-925-1439
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000055691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5010186Medicaid