Provider Demographics
NPI:1407242464
Name:GAILEY, ADAM RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RICHARD
Last Name:GAILEY
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 1:24902 JERICHO TPKE STE 101
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4000
Mailing Address - Country:US
Mailing Address - Phone:516-354-1700
Mailing Address - Fax:
Practice Address - Street 1:24902 JERICHO TPKE STE 101
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4000
Practice Address - Country:US
Practice Address - Phone:516-354-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058742-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist