Provider Demographics
NPI:1437345170
Name:NICKIE L GALE DDS PA
Entity Type:Organization
Organization Name:NICKIE L GALE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-764-6367
Mailing Address - Street 1:13237 W 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2388
Mailing Address - Country:US
Mailing Address - Phone:913-764-6367
Mailing Address - Fax:913-764-6387
Practice Address - Street 1:304 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1725
Practice Address - Country:US
Practice Address - Phone:913-764-6367
Practice Address - Fax:913-764-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty