# GALLERY MALL DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GALLERY MALL DENTAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902051535
- **Legal business name:** GALLERY MALL DENTAL
- **Authorized official:** PROLAY KUMAR PAUL D.D.S (PARTNER)
- **Authorized official phone:** (215) 627-4290

## Contact information

- **Practice address:** 901 MARKET ST, SPACE 3220 GALLERY MALL ONE, PHILADELPHIA, PA 19107
- **Practice address phone:** (215) 627-4290
- **Practice address fax:** (215) 627-4293
- **Mailing address:** 901 MARKET ST, SPACE 3220, PHILADELPHIA, PA 19107
- **Mailing address phone:** (215) 627-4290
- **Mailing address fax:** (215) 627-4293

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS037088 | PA | — |
| 122300000X | Dentist | DS037098 | PA | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |

## Other

- **Enumeration date:** 11/24/2008
- **Last updated:** 12/18/2009