Provider Demographics
NPI:1902574346
Name:GALLUP, GINA (DDS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GALLUP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N ORANGE ST UNIT 535
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-5519
Mailing Address - Country:US
Mailing Address - Phone:440-622-0320
Mailing Address - Fax:
Practice Address - Street 1:221 WESTWOOD PLAZA SUITE 222
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2639
Practice Address - Country:US
Practice Address - Phone:310-220-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist