Gallery Mall Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

DS037098 Issued in PA

Legal business name

GALLERY MALL DENTAL PC

Practice address

901 Market St
Space 3220 Gallery Mall One
Philadelphia, PA 19107

Phone

(215) 627-4290

Fax

(215) 627-4293

NPI assigned

Nov 24, 2008

Organization subpart

Yes

Parent organization

GALLERY MALL DENTALAs reported in NPPES

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

Authorized official

Name

Prolay Kumar Paul, D.D.S

Title

Partner

Phone

(215) 627-4290

Specialties & licenses 3

Addresses

Tax ID family

Gallery Mall Dental PC2 organizations share this tax ID, including this one

Part of

Gallery Mall Dental PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Franklin Mills Mall Dental

  • Dentist
  • Philadelphia, PA
  • NPI 1831426170
  NPD tax ID

Locations

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261094400000",
    "number": "1902051535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MARKET ST",
            "address_2": "SPACE 3220",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-627-4290",
            "fax_number": "215-627-4293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MARKET ST",
            "address_2": "SPACE 3220 GALLERY MALL ONE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-627-4290",
            "fax_number": "215-627-4293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLERY MALL DENTAL PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GALLERY MALL DENTAL",
        "enumeration_date": "2008-11-24",
        "last_updated": "2009-12-18",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "PROLAY",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "215-627-4290",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037098",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS037088",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Gallant, RD
• Susan D Gallardo, CRNP
• Michael F Gallaway
• Raegan Galleher
• Gallery Eye Associates, LLC
• Karen Galli, D.P.M.
• Lisa Galliera, CRNA
• Kathleen Galligan, PA-C
• Meghan Galligan, M.D.
• Deborah Gallihue, CRNP

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; 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.