Provider Demographics
NPI:1700041613
Name:GALLAGHER, JESSE H (DMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:H
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 1:540 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5544
Mailing Address - Country:US
Mailing Address - Phone:541-476-7781
Mailing Address - Fax:541-471-9366
Practice Address - Street 1:540 UNION AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5544
Practice Address - Country:US
Practice Address - Phone:541-476-7781
Practice Address - Fax:541-471-9366
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist