Provider Demographics
NPI:1679690085
Name:GALLAGHER, ROBIN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:F
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E CHESTNUT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2715
Mailing Address - Country:US
Mailing Address - Phone:215-242-6404
Mailing Address - Fax:
Practice Address - Street 1:2 E CHESTNUT HILL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2715
Practice Address - Country:US
Practice Address - Phone:215-242-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021970-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice