Organization
DR THOMAS A GALLIVAN, JR, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A GALLIVAN JR. DDS (PRESIDENT)
(802) 773-1393
Entity
Organization
Contact information
Practice address
198 NORTH MAIN STREET, RUTLAND, VT 05701
(802) 773-1393
Mailing address
198 NORTH MAIN STREET, RUTLAND, VT 05701
(802) 773-1393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
016-0000583
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001719
—
VT
Enumeration date
10/08/2008
Last updated
10/08/2008
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