Provider Demographics
NPI:1700898616
Name:ANTHONY G. GALLEGOS, DDS, INC
Entity type:Organization
Organization Name:ANTHONY G. GALLEGOS, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-777-8884
Mailing Address - Street 1:4915 YORBA RANCH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2508
Mailing Address - Country:US
Mailing Address - Phone:714-777-5973
Mailing Address - Fax:
Practice Address - Street 1:4915 YORBA RANCH RD
Practice Address - Street 2:SUITE C
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2508
Practice Address - Country:US
Practice Address - Phone:714-777-5973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty