Provider Demographics
NPI:1053114116
Name:GALLEGOS, RHIANNON L (RDH)
Entity type:Individual
Prefix:MS
First Name:RHIANNON
Middle Name:L
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1638
Mailing Address - Country:US
Mailing Address - Phone:719-989-7464
Mailing Address - Fax:
Practice Address - Street 1:2041 PEPPER LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3276
Practice Address - Country:US
Practice Address - Phone:719-415-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000906235124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty