Provider Demographics
NPI:1346245941
Name:GALE, MARIE A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:GALE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994 W RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-9295
Mailing Address - Country:US
Mailing Address - Phone:239-936-2221
Mailing Address - Fax:
Practice Address - Street 1:1994 W RIVER AVE
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9295
Practice Address - Country:US
Practice Address - Phone:239-936-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN85211223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072702400Medicaid
FLT54854Medicare UPIN
FL072702400Medicaid