Provider Demographics
NPI:1720172240
Name:GALLEGLY, ELIZABETH T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:T
Last Name:GALLEGLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18251 ROSCOE BLVD STE 201A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4254
Mailing Address - Country:US
Mailing Address - Phone:818-700-1247
Mailing Address - Fax:818-885-0762
Practice Address - Street 1:18251 ROSCOE BLVD STE 201A
Practice Address - Street 2:18251 ROSCOE BLVD., STE. 201A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4254
Practice Address - Country:US
Practice Address - Phone:818-700-1247
Practice Address - Fax:818-885-0762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice