Provider Demographics
NPI:1962528042
Name:GALLO, RICHARD ANTHONY
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:GALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:ANTHONY
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2156 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4227
Mailing Address - Country:US
Mailing Address - Phone:914-962-5100
Mailing Address - Fax:914-962-5157
Practice Address - Street 1:2156 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4227
Practice Address - Country:US
Practice Address - Phone:914-962-5100
Practice Address - Fax:914-962-5157
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0352251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice