Individual
ASA NATHANIEL GALLUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
218 W 2ND AVE, CORSICANA, TX 75110-3003
(903) 872-3981
Mailing address
218 W 2ND AVE, CORSICANA, TX 75110-3003
(903) 872-3981
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17139
TX
Other
Enumeration date
09/08/2008
Last updated
05/04/2016
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