Provider Demographics
NPI:1083800486
Name:GALICKI, GARY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:GALICKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:J
Other - Last Name:GALICKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:605 AIKEN AVE
Mailing Address - Street 2:P.O.BOX 774
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-2730
Mailing Address - Country:US
Mailing Address - Phone:410-642-2120
Mailing Address - Fax:
Practice Address - Street 1:605 AIKEN AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2730
Practice Address - Country:US
Practice Address - Phone:410-642-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD49101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice