Provider Demographics
NPI:1447356639
Name:GALLUP DENTAL INC
Entity type:Organization
Organization Name:GALLUP DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-872-3981
Mailing Address - Street 1:218 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-872-3981
Mailing Address - Fax:903-872-0835
Practice Address - Street 1:218 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:903-872-3981
Practice Address - Fax:903-872-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17139122300000X
TX18748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty