Individual provider Active NPI

Richard Alan Galow, DDS

  • General Practice Dentistry
  • Fond Du Lac, WI
National Provider Identifier
1639284953
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4001877E Issued in WI
Practice address
21 N Portland St
Fond Du Lac, WI 54935-3465
Phone
(920) 921-1150
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
Yes

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 4001877E WI Primary

Addresses

Primary practice location

21 N Portland St
Fond Du Lac, WI 54935-3465

Mailing address

21 N Portland St
Fond Du Lac, WI 54935-3465
Phone (920) 921-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4001877EWIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639284953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 N PORTLAND ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353465",
            "telephone_number": "920-921-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 N PORTLAND ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353465",
            "telephone_number": "920-921-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALOW",
        "first_name": "RICHARD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4001877E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.