Provider Demographics
NPI:1023179181
Name:GALLAGHER, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GALLAGHER
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 1:11800 SINGLETREE LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5328
Mailing Address - Country:US
Mailing Address - Phone:952-942-9600
Mailing Address - Fax:952-942-3371
Practice Address - Street 1:11800 SINGLETREE LN
Practice Address - Street 2:SUITE 208
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5328
Practice Address - Country:US
Practice Address - Phone:952-942-9600
Practice Address - Fax:952-942-3371
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice