Provider Demographics
NPI:1730452319
Name:GALLICK, TESSA SUSAN (DMD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:SUSAN
Last Name:GALLICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 US HIGHWAY 206
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1538
Mailing Address - Country:US
Mailing Address - Phone:207-576-3354
Mailing Address - Fax:908-359-4557
Practice Address - Street 1:760 US HIGHWAY 206
Practice Address - Street 2:SUITE 2
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1538
Practice Address - Country:US
Practice Address - Phone:207-576-3354
Practice Address - Fax:908-359-4557
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02492700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist