Provider Demographics
NPI:1487733317
Name:GALLIEN, JOHN H (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:GALLIEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COLLEGE ST
Mailing Address - Street 2:P.O. BOX 280
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2078
Mailing Address - Country:US
Mailing Address - Phone:731-925-4971
Mailing Address - Fax:731-925-5303
Practice Address - Street 1:165 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2078
Practice Address - Country:US
Practice Address - Phone:731-925-4971
Practice Address - Fax:731-925-5303
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND.S. 1337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3210516Medicare ID - Type Unspecified
TNT74169Medicare UPIN