Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 7746317-9921 | UT |
NPI | 1013252725 |
---|---|
Provider Name | Francisco F. Gallardo JR. |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Nellis Afb, NV 89191-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 15/06/2021 |