Provider Demographics
NPI:1871701615
Name:GALL, MEGAN CYDNEY (RDH)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CYDNEY
Last Name:GALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CYDNEY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CORTE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2111
Mailing Address - Country:US
Mailing Address - Phone:650-652-2481
Mailing Address - Fax:
Practice Address - Street 1:407 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1614
Practice Address - Country:US
Practice Address - Phone:650-329-9124
Practice Address - Fax:650-329-9146
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22088124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist