1609068600 NPI number — DR. GERMAN OSCAR GALLUCCI DMD, DR. MED. DENT.

Table of content: DR. GERMAN OSCAR GALLUCCI DMD, DR. MED. DENT. (NPI 1609068600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609068600 NPI number — DR. GERMAN OSCAR GALLUCCI DMD, DR. MED. DENT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLUCCI
Provider First Name:
GERMAN
Provider Middle Name:
OSCAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, DR. MED. DENT.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609068600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
188 LONGWOOD AVE
Provider Second Line Business Mailing Address:
HARVARD SCHOOL OF DENTAL MEDICINE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-432-5764
Provider Business Mailing Address Fax Number:
617-432-0901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
HARVARD SCHOOL OF DENTAL MEDICINE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-432-5764
Provider Business Practice Location Address Fax Number:
617-432-0901
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  4993 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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