Provider Demographics
NPI:1720062383
Name:GALES, SALVADOR EBREO (DMD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:EBREO
Last Name:GALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11806 ROCKAWAY BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2420
Mailing Address - Country:US
Mailing Address - Phone:718-843-0263
Mailing Address - Fax:718-843-0045
Practice Address - Street 1:11806 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2420
Practice Address - Country:US
Practice Address - Phone:718-843-0263
Practice Address - Fax:718-843-0045
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice