Provider Demographics
NPI:1023639010
Name:GALLINA, RONNI RENEE
Entity type:Individual
Prefix:
First Name:RONNI
Middle Name:RENEE
Last Name:GALLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5254
Mailing Address - Country:US
Mailing Address - Phone:903-922-3506
Mailing Address - Fax:
Practice Address - Street 1:1501 E LOOP 304 STE 100
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-3417
Practice Address - Country:US
Practice Address - Phone:903-376-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12700124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist