Provider Demographics
NPI:1861555740
Name:JOSE E. GALLEGOS, D.D.S., P.C.
Entity type:Organization
Organization Name:JOSE E. GALLEGOS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-739-9830
Mailing Address - Street 1:5424 SUNRISE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2516
Mailing Address - Country:US
Mailing Address - Phone:804-739-4972
Mailing Address - Fax:804-739-9543
Practice Address - Street 1:13861 HULL STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2003
Practice Address - Country:US
Practice Address - Phone:804-739-9190
Practice Address - Fax:804-739-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty