Provider Demographics
NPI:1912077157
Name:GALLOMBARDO, JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GALLOMBARDO
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 1:2 KEVIN WAY
Mailing Address - Street 2:
Mailing Address - City:EVESHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2514
Mailing Address - Country:US
Mailing Address - Phone:856-983-5570
Mailing Address - Fax:856-988-7547
Practice Address - Street 1:2 KEVIN WAY
Practice Address - Street 2:
Practice Address - City:EVESHAM
Practice Address - State:NJ
Practice Address - Zip Code:08053-2514
Practice Address - Country:US
Practice Address - Phone:856-983-5570
Practice Address - Fax:856-988-7547
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist