Provider Demographics
NPI:1760529234
Name:GALLAGHER, CAROL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36600 HERITAGE DR.
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062
Mailing Address - Country:US
Mailing Address - Phone:586-727-3815
Mailing Address - Fax:586-727-3950
Practice Address - Street 1:36600 HERITAGE DR.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062
Practice Address - Country:US
Practice Address - Phone:586-727-3815
Practice Address - Fax:586-727-3950
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice