# TRISTAN GALLOWAY DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942600390
- **Authorized official:** TRISTAN SUMNER GALLOWAY DDS (OOWNER/OPERATOR)
- **Authorized official phone:** (208) 466-4261

## Contact information

- **Practice address:** 820 17TH AVE S, NAMPA, ID 83651-4740
- **Practice address phone:** (208) 466-4261
- **Practice address fax:** (208) 466-6288
- **Mailing address:** 820 17TH AVE S, NAMPA, ID 83651-4740
- **Mailing address phone:** (208) 466-4261
- **Mailing address fax:** (208) 466-6288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4321 | ID | Yes |

## Other

- **Enumeration date:** 09/03/2014
- **Last updated:** 09/03/2014