Provider Demographics
NPI:1982875654
Name:GALA, AMY MAHEN (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MAHEN
Last Name:GALA
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 1:14 COLTS GAIT ROAD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1316
Mailing Address - Country:US
Mailing Address - Phone:609-280-0344
Mailing Address - Fax:
Practice Address - Street 1:14 COLTS GAIT RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-5710
Practice Address - Country:US
Practice Address - Phone:609-280-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053795-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist