Provider Demographics
NPI:1053560474
Name:GALLOWAY, THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BAUGHMANS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4894
Mailing Address - Country:US
Mailing Address - Phone:301-662-0554
Mailing Address - Fax:
Practice Address - Street 1:101 BAUGHMANS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4894
Practice Address - Country:US
Practice Address - Phone:301-662-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist