Galleria Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GALLERIA ORAL AND MAXILLOFACIAL SURGERY

Practice address

911 Reserve Drive
Suite #150
Roseville, CA 95678

Phone

(916) 783-2110

Fax

(916) 783-2111

NPI assigned

Jan 30, 2014

Last updated

Jan 30, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yelena Myalik

Title

Office Manager

Phone

(916) 783-2110

Specialties & licenses 1

Addresses

Other names 1

• Alexander O. Antipov, D.D.S., Inc Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1407279177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 RESERVE DRIVE",
            "address_2": "SUITE #150",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95678",
            "telephone_number": "916-783-2110",
            "fax_number": "916-783-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 RESERVE DRIVE",
            "address_2": "SUITE #150",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95678",
            "telephone_number": "916-783-2110",
            "fax_number": "916-783-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLERIA ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "MYALIK",
        "authorized_official_first_name": "YELENA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "916-783-2110"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alexander O. Antipov, D.D.S., Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Susan M Gallagher
• Desiree Rose Gallamore, RN
• George Kurt Gallardo, M.D.
• Maria C Gallardo, M.S.
• Nancy Ann Gallerani
• Beatriz Regina Galofre, DDS
• Dario A. Gambetta, MD
• Brian Gamez, MS, CCC-SLP
• Sakshi Amal Gangodkar
• Antoine Philippe Ganivet

• Oral and Maxillofacial Surgery (Dentist) in Roseville, CA
• Providers in Roseville, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.