Galleria Mall Dental PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

042707 Issued in NY

Legal business name

GALLERIA MALL DENTAL PC

Practice address

1 N Galleria Dr Ste 141
Middletown, NY 10941-3030

Phone

(845) 692-9212

Fax

(845) 692-9215

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Ross Krasnov

Title

Office Administrator

Phone

(845) 692-9212

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1932326618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N GALLERIA DR STE 141",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109413030",
            "telephone_number": "845-692-9212",
            "fax_number": "845-692-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 N GALLERIA DR STE 141",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109413030",
            "telephone_number": "845-692-9212",
            "fax_number": "845-692-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLERIA MALL DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KRASNOV",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "845-692-9212"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "049213",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "052828",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "048760",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "042707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Lynn Galaydick, MD
• Hanna Gallagher
• John Thomas Gallagher, NP
• Lorraine Cheryl Gallagher
• Jade Jenny S Gallardo, MD
• Viviana Beatriz Galli, MD
• Michelle Galligan, NP
• Lindsey Galusha, PHARMD
• Geraldine Alejandro Gamboa, L.P.N.
• Maris Lauren Gamzon

• Periodontics in Middletown, NY
• Providers in Middletown, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.