Individual provider Active NPI

Rosalia Gallo, DMD

  • General Practice Dentistry
  • Southbury, CT
National Provider Identifier
1417166406
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8409 Issued in CT
Practice address
250 Main St S
Southbury, CT 06488-2263
Phone
(203) 264-9606
Fax
(203) 264-4288
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8409 CT Primary

Addresses

Primary practice location

250 Main St S
Southbury, CT 06488-2263

Mailing address

250 Main St S
Southbury, CT 06488-2263
Phone (203) 264-9606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150319001939 MA Order and Referring Only - DentistPractitioner - Dentist 5799002325

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8409CTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417166406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MAIN ST S",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882263",
            "telephone_number": "203-264-9606",
            "fax_number": "203-264-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MAIN ST S",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882263",
            "telephone_number": "203-264-9606",
            "fax_number": "203-264-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLO",
        "first_name": "ROSALIA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "8409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

Verify at the official NPI Registry.