1972523884 NPI number — ROBERT A. GALLEGOS, DDS, PC

Table of content: (NPI 1972523884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972523884 NPI number — ROBERT A. GALLEGOS, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT A. GALLEGOS, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1972523884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 386
Provider Second Line Business Mailing Address:
204 E FEDERAL STREET
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20118-0386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-687-6363
Provider Business Mailing Address Fax Number:
540-687-6733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E FEDERAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20118-0386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-687-6363
Provider Business Practice Location Address Fax Number:
540-687-6733
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLEGOS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-687-6363

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6392 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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