Provider Demographics
NPI:1720273071
Name:GALLO, ENRIQUE JOSE (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JOSE
Last Name:GALLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2854
Mailing Address - Country:US
Mailing Address - Phone:786-845-0800
Mailing Address - Fax:786-845-0803
Practice Address - Street 1:10830 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2854
Practice Address - Country:US
Practice Address - Phone:786-845-0800
Practice Address - Fax:786-845-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-159731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics