Organization Name: | DR KENNETH R GALLION A PROFESSIONAL DENTAL CORP |
NPI Number: | 1134201361 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH R GALLION (DENTIST OWNER PRESIDENT) |
Mailing Address: | 68820 Ramon Rd Cathedral City |
State: | CA US |
Postal Code: | 92234 |
Phone Number: | 7607700236 |
Fax Number: | 7607709758 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 39405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |